European Geriatric Medicine - Supplement 1 - Volume 7 - October 2016

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Conclusion: Hospitalized patients aged 75 and over are often
prescribed anticholinergic drugs. This exposure can occur in situations
at high risk of ADR.
P-760
Potentially inappropriate medication prescribing is associated
with socioeconomic factors: a spatial analysis in the French Nord-
Pas-de-Calais Region
J.-B. Beuscart1,2, M. Genin2, C. Dupont3, M.-M. Defebvre3, D. Verloop3,
A. Duhamel2, F. Puisieux1,2. 1CHU Lille, Geriatric Department, 2Univ. Lille,
EA 2694, 3ARS Nord-Pas-de-Calais, Lille, France
Background: Potentially inappropriate medication (PIM) prescribing
is common in the elderly and lead to adverse events and hospital
admissions. This study aimed to determinewhether prevalence of PIM
prescribing varies according to healthcare facilities and socioeconomic
status in a French region.
Methods: All prescriptions dispensed at community pharmacies for
patients aged 75 and older between January 1 and March 31, 2012
were retrieved from French Health Insurance Information System
of the Nord-Pas-de-Calais Region for patients affiliated to the
Social Security scheme. PIM was defined according to the French list
of Laroche. The geographic distribution of PIM prescribing in this area
was analyzed using spatial scan statistics.
Results: 65.6% (n = 207,979) of people aged 75 years and over living in
the Nord-Pas-de-Calais Region were included. Among them, 32.6%
(n = 67,863) received at least one PIM prescribing. The spatial analy-
sis identified 16 and 10 clusters of municipalities with a high and a
low prevalence of PIM prescribing, respectively. Municipalities with
a low PIM prevalence were characterized by markers of a high
socioeconomic status whereas those with a high PIM prevalence were
mainly characterized by markers of a low socioeconomic status, such
as a high unemployment rate and low household incomes. Markers
of healthcare facilities were weakly associated with high or low
prevalence clusters.
Conclusion: Spatial distribution of PIM prescribing was heteroge-
neous in the study territory and was mainly associated with
socioeconomic factors.
P-761
Tramadol prescriptions in older, hospitalized patients
L. Ferret1, G. Ficheur1, S. De Courreges1, E. Boulanger2, M. Luyckx3,4,
S. Quenton 1, R. Beuscart1, E. Chazard1, J.-B. Beuscart1,2. 1Univ. Lille, EA
2694, 2CHU Lille, Geriatrics Department, Lille, 3Denain general hospital,
Pharmacy Department, Denain, 4Univ. Lille, EA GRITA, Lille, France
Introduction: Tramadol is often used in the pharmacological manage-
ment of pain in older patients, but there are few data on the safety
of tramadol in routine practice for these patients. The objective of the
present study was to describe prescriptions of tramadol in older
hospitalized patients, with focus on clinically significant drug-drug
interactions (DDI) and gastrointestinal adverse drug reactions (ADR).
Methods: Using a database from a French general hospital, we
extracted information between 2011 and 2013 by patients aged
75 and over. Analgesic prescriptions were automatically detected in
patients aged 75 and over. Clinically significant DDI involving
tramadol were detected according the Theriaque ® compendium.
Gastrointestinal ADRs were indirectly detected by the administration
of a laxative or antiemetic following the administration of tramadol.
Results: 7,362 hospital stays were included with a mean age of
83.8 ± 5.3 years. An administration of tramadol was identified in 16.2%
(n = 1,092) of the total stays by patients aged 75 and over and
represented 83.4% of step 2 analgesics administrations (n = 1,309). DDI
involving tramadol were frequent (n = 415; 38.0% of tramadol
administration) but seldom concerned DDI contraindicated or to
avoid (n = 11). Most DDI were related to association to benzodiazepines
or drugs that lower the epileptogenic threshold. According to the
Kramer ’s algorithm, 322 gastrointestinal ADR occurred in 27.0% (295)
of the 1,092 stays with administration of tramadol.
Conclusion: Tramadol is frequently administrated in older, hospita-
lized patients and is associated with gastrointestinal ADR in more
than one of four patients.
P-762
Prescribing habits in severe renal impairment at a local geriatric
hospital in Malta: a quality improvement project
M. Bonnici1, S. Buttigieg1, M. Gauci2, P. Ferry2, A. Fiorini 2, K. Zammit2.
1Mater Dei Hospital, L-Imsida, 2Rehabilitation Hospital Karin Grech,
Pieta, Malta
Introduction: Renal disease alters the effects of many drugs,
potentially causing toxicity, with certain drugs needing omission and
others dose adjustment. This study aimed to audit drug prescribing
in patients with severe renal impairment at Rehabilitation Hospital
Karin Grech (RHKG).
Method: Treatment charts of patients with severe renal impairment
(eGFR <30 mL/min/1.73 m2) at RHKG between December 2015 and
January 2016 were assessed for compliance to advice on the British
National Formulary 70.
Following this, a sticker indicating the eGFR was affixed to treatment
charts of patients with severe renal impairment. A lecture on
prescribing in renal impairment was delivered to prescribers at RHKG.
In a second cycle carried out at the end of April 2016, treatment charts
of patients with an eGFR <30 mL/min/1.72 m2 from wards of RHKG
were analysed.
Results: The number of patients with an eGFR <30 mL/min/1.73 m 2
was 36 (12.9% of inpatients) and 22 (7.9%), in the first and second cycles
respectively.
The percentage of patients with inappropriate prescriptions decreased
from 75% in the first cycle to 59% in the second (p = 0.2).
The number of incorrect entries on treatment charts fell from 12.5%
in the first cycle to 7.52% in the second cycle (p = 0.05).
Conclusion: A lecture, coupled with the introduction of the eGFR
sticker, improved doctors prescribing in severe renal impairment.
P-763
Older patients on amiodarone: an audit on the monitoring of
thyroid and liver function tests
S. Buttigieg1, M. Bonnici1, M. Grech 2, A. Fiorini3. 1Mater Dei Hospital,
L-Imsida, 2St Vincent de Paule Long Term Care Facility, Luqa,
3Rehabilitation Hospital Karin Grech, Pieta, Malta
Introduction: The use of amiodarone in the management of tachy-
arrhythmias needs monitoring of thyroid function tests (TFTs) and
liver function tests (LFTs) on a regular basis.
Method: Patients on amiodarone at Rehabilitation Hospital Karin
Grech and at St Vincent de Paul Long Term Care Facility were identified
by examining the admissions’ treatment charts. The indication for
treatment, together with TFTs and LFTs on admission and at six
months were recorded.
Results: Out of 1355 treatment charts examined, 42 (3.1%) patients
were on amiodarone. The most common indication for treatment
was atrial fibrillation (88%, n = 37). 54.8% (n = 23) had baseline TFTs
checked whilst 57.1% (n = 24) had baseline LFTs checked. A total of 38
patients had been on amiodarone for more than 6 months and of
these 7.9% (n = 3) had TFTs and LFTs measured at 6 monthly intervals.
26.2% (n = 11) had subclinical hypothyroidism. 40.5% (n = 17) had an
abnormal alanine aminotransferase level at some point during
treatment. An ECG was taken for 67% (n = 28) of individuals in the
previous 12 months. 52.4% (n = 22) were found to be in normal sinus
rhythm and 50% (n = 21) had an abnormal corrected QT interval. This
study was compared to another carried out 10 years prior involving
the same institutions and a comparable study population. Baseline
TFTs recorded increased by 15.7 percentage points whereas that of 6
monthly TFTs increased by 9 percentage points.
Key conclusion: While some improvement has occurred in the
monitoring of patients on amiodarone, the study highlights areas
were improvement is still desirable.
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S230