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Abstract
Background
Multimorbidity frequently necessitates complex pharmacotherapy and increases the risk of polypharmacy, potentially inappropriate medications, prescribing omissions, and other medication-related problems. Evidence regarding prescribing appropriateness among multimorbid patients in Pakistan remains limited.
Objective
To determine the prevalence and patterns of potentially inappropriate prescribing and medication-related problems and identify their predictors among older patients with multimorbidity attending tertiary-care hospitals in Lahore, Pakistan.
Methods
A multicentre analytical cross-sectional study was designed among patients aged ≥65 years with at least two chronic conditions and receiving at least two regular medications. The minimum sample was calculated using the single-population proportion formula. After adjustment for 10% incomplete or non-participating cases, the target sample was 427. Prescribing appropriateness was assessed using the Screening Tool of Older Persons’ Prescriptions/Screening Tool to Alert to Right Treatment version 3—STOPP/START v3. Medication-related problems were classified using the Pharmaceutical Care Network Europe, PCNE, version 9.1 framework. Descriptive analysis, chi-square tests, Spearman correlation, and multivariable binary logistic regression were planned.
Results
Among 427 participants, the mean age was 72.8±6.4 years, 223 (52.2%) were men, and 289 (67.7%) experienced polypharmacy. At least one potentially inappropriate prescribing event was identified in 240 patients (56.2%; 95% confidence interval [CI]: 51.5–60.9). STOPP-defined potentially inappropriate medications were present in 183 (42.9%; 95% CI: 38.2–47.6), while START-defined prescribing omissions were found in 139 (32.6%; 95% CI: 28.1–37.0). At least one medication-related problem occurred in 285 patients (66.7%; 95% CI: 62.3–71.2). A total of 611 medication-related problems were identified, predominantly treatment-safety problems (40.4%). Hyperpolypharmacy independently predicted medication-related problems (adjusted odds ratio [aOR]: 6.12; 95% CI: 2.82–13.29) and potentially inappropriate prescribing (aOR: 5.08; 95% CI: 2.53–10.21). Four or more chronic conditions and renal impairment were also significant predictors.
Conclusion
The findings indicate that potentially inappropriate prescribing and medication-related problems affect a substantial proportion of older multimorbid patients in Lahore. Prospective pharmacist-led medication review, medication reconciliation, renal-dose monitoring, and structured deprescribing services should be evaluated in local healthcare settings.