Drug utilization patterns among elderly hospitalized patients on poly-pharmacy in Punjab, Pakistan

Background: Reports from drug utilization reviews are important tools employed in the assessment of healthcare
practices. The objective of this study was to evaluate drug utilization patterns among elderly hospitalized patients
on poly-pharmacy regimens in Pakistan.

Methods: A descriptive, non-experimental, cross-sectional study was carried out from December 2015 to March
2016 in six tertiary-care hospitals in the Punjab province of Pakistan. The population under study were patients
aged ≥60 years, taking ≥5 medicines per day (i.e., patients on poly-pharmacy) and who were hospitalized in the
selected tertiary-care hospitals. In this study, data was collected from 600 hospitalized elderly patients (100 patients
per hospital). All medicines prescribed on each in-patient chart were noted on a pre-designed pro-forma sheet and
were classified under the Anatomical Therapeutic Chemical (ATC) classification system. Multiple linear regression
analysis was used to determine the independent factors associated with poly-pharmacy in this cohort. Statistical
Package for Social Sciences (SPSS) was used to analyze the data. P-value < .05 indicated statistical significance.

Results: In 600 hospitalized in-patient (male 52.7% and female 47.3%) medication charts, 3179 medicines were
prescribed. The most commonly prescribed drug classes were: A: alimentary tract and metabolism 80% (A02: drugs
for acid related disorders 64.5%, A03: drugs for functional gastrointestinal disorders 21.5%), N: nervous system 66.3%
(N02: analgesics 67.2%, N03: antiepileptic’s 11.2%), J: anti-infectives for systemic use 62.2% (J01: antibacterial for
systemic use 82.5%, J04: antimycobacterials 15.3%) and C: cardiovascular system 48.3% (C07: beta blocking agents
19.8%, C10: lipid modifying agents 16.5%), respectively. The most commonly prescribed active substances were:
A02BC01 (omeprazole 51.3%), N02BE01 (paracetamol 50.8%) and J01DD04 (ceftriaxone 40.2%), respectively. In
multiple linear regression analysis, male gender (95% CI −.205, −.006, p = .039, B = −.091), being divorced
(95% CI −.604, −.136, p = .002, B = −.130) and presence of comorbidity (95% CI .068, .267, p = .001, B = .144) were
the independent factors associated with increased drug use among elderly hospitalized patients on poly-pharmacy.

Conclusions: The rational use of medicines is of utmost importance, most particularly in the elderly population.
More consideration should be given to rationalizing pharmacotherapy in elderly hospitalized patients who are on
poly-pharmacy regimens in Pakistan.