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

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

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.

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.

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.