Department of Clinical Pharmacy, School of Pharmacy, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia.
Department of Internal Medicine, School of Medicine, Institute of Health, Jimma University, Jimma, Ethiopia.
BMC Geriatr. 2024 Jan 16;24(1):65. doi: 10.1186/s12877-024-04688-w.
Evidence shows that potentially inappropriate medication (PIM) use in older adults significantly increases the utilization of healthcare resources. PIM is widely prescribed in older adults, however little is known about its association with healthcare resource utilization in Africa, particularly Ethiopia. Therefore, the primary aim of this study was to examine the presence of an association between healthcare expenditure and the frequency of PIM used.
This observational study was conducted from 06 September 2021 to 30 December 2022. A total of 151 hospitalized older adult patients were included in the study. The data collection format was designed to capture relevant information. STATA V.15.0 was used for analysis. Descriptive statistics and a generalized linear model regression were conducted. Statistical significance was set at a p-value < 0.05. The findings are presented in tables, figures, and text.
The total healthcare expenditure was higher in PIM users (385,368.6 ETB) than in non-PIM users (131,267.7 ETB). The median expenditures for medical supplies (p = 0.025), investigations (p = 0.033), and total healthcare expenditure (p = 0.023) were significantly higher in patients with two and more PIMs than in those with no or one PIM. However, after model adjustment, the total healthcare expenditure was not significantly different across the frequency of PIMs used. Number of medications (adjusted B = 0.068, 95% CI: 0.035, 0.101, p < 0.001) and taking blood and blood-forming organ class of medication (adjusted B = 0.151, 95% CI: 0.005, 0.297, p = 0.042) were associated with higher total healthcare expenditure, whereas the total healthcare expenditure was significantly lower in those patients with diseases of the nervous system (adjusted B = -0.307, 95% CI: -0.502, -0.112, p = 0.002) and respiratory system (adjusted B = -0.196, 95% CI: -0.327, -0.065, p = 0.003).
The total healthcare expenditure is nearly three times higher in PIM users. However, its association with the frequency of PIM use was not statistically significant in the final model. Deprescribing medications after evaluating the benefit-risk ratio may help to reduce the healthcare expenditures of older adult patients. Further similar, adequately powered, comparative study is also warranted to identify the actual effect of PIM use on healthcare expenditures in the local context.
有证据表明，老年人中潜在不适当用药（PIM）的使用显著增加了医疗保健资源的利用。PIM 在老年人中广泛使用，但关于其与非洲，特别是埃塞俄比亚的医疗保健资源利用之间的关系知之甚少。因此，本研究的主要目的是检查医疗支出与 PIM 使用频率之间是否存在关联。
这项观察性研究于 2021 年 9 月 6 日至 2022 年 12 月 30 日进行。共纳入 151 名住院老年患者。数据收集格式旨在捕获相关信息。使用 STATA V.15.0 进行分析。进行描述性统计和广义线性模型回归。设定统计显著性水平为 p 值<0.05。研究结果以表格、图形和文本形式呈现。
PIM 使用者（385368.6 埃镑）的总医疗支出高于非 PIM 使用者（131267.7 埃镑）。在有两种或更多种 PIM 的患者中，医疗用品（p=0.025）、检查（p=0.033）和总医疗支出（p=0.023）的中位数支出明显更高，而在没有或只有一种 PIM 的患者中则没有显著差异。然而，在模型调整后，PIM 使用频率对总医疗支出没有显著影响。用药数量（调整后的 B=0.068，95%CI：0.035，0.101，p<0.001）和使用血液和造血器官类药物（调整后的 B=0.151，95%CI：0.005，0.297，p=0.042）与总医疗支出较高相关，而患有神经系统疾病（调整后的 B=-0.307，95%CI：-0.502，-0.112，p=0.002）和呼吸系统疾病（调整后的 B=-0.196，95%CI：-0.327，-0.065，p=0.003）的患者总医疗支出显著较低。
PIM 使用者的总医疗支出几乎是三倍。然而，在最终模型中，其与 PIM 使用频率之间的关联并不具有统计学意义。在评估利弊比后，减少药物的使用可能有助于降低老年患者的医疗保健支出。还需要进行类似的、充分有力的、比较性研究，以确定 PIM 使用对当地医疗保健支出的实际影响。
