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General practitioners' prescribing patterns for the elderly in a province of Iran

Authors

  • Hadi Ghadimi,

    Corresponding author
    1. Department of Public Health Sciences, Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
    • Department of Public Health Sciences, Division of Global Health (IHCAR), Karolinska Institutet, Nobels väg 9, 17177 Stockholm, Sweden.
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  • Hamideh M. Esmaily,

    1. Department of Public Health Sciences, Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
    2. National Public Health Management Center (NPMC) and Educational Development Center (EDC), Tabriz University of Medical Sciences, Tabriz, Iran
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  • Rolf Wahlstrom

    1. Department of Public Health Sciences, Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
    2. Department of Public Health and Caring Sciences, Family Medicine and Epidemiology, Uppsala University, Uppsala, Sweden
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  • The research was conducted at Tabriz University of Medical Sciences, Iran and Karolinska Institutet, Sweden.

ABSTRACT

Purpose

To determine prescribing patterns by general physicians working in primary care (GPs) in Iran for the elderly and the prevalence of inappropriate prescribing.

Methods

We collected information about prescribed medicines for 10% of patients in primary care aged 65 years or above in six cities in one province during two separate months 1 year apart. Inappropriate prescribing was determined using Beers criteria, excluding diagnosis-related medications. The WHO indicators for appropriateness of prescribing in general practice and drug–drug interactions (DDIs) were also assessed.

Results

A total of 2041 patients were studied (mean age 73 years, 56% were women). Drugs for the alimentary system (20%), nervous system (15%), cardiovascular system (14%), and anti-infectives (12%) were most frequently prescribed. Almost all drugs (96%) were prescribed by generic names. Thirty percent of patients received at least one inappropriate drug (27% for men; 33% for women), whereof 94% were categorized as high risk for adverse effects. Indomethacin, diphenhydramine, and methocarbamol were the most common inappropriate medications. The average number of drugs per patient was 4.4 (4.2 for men; 4.5 for women). Forty-four percent of patients received five or more drugs. Antibiotics and injections were prescribed in 39 and 55% of all patients, respectively. Clinically relevant DDIs were observed for 14% of the patients.

Conclusion

Our findings call for further interventions aiming at educating GPs to reduce potential errors. National drug policies and prescribing guidelines should be implemented to address the problem of inappropriate drug usage among the elderly. Copyright © 2011 John Wiley & Sons, Ltd.

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