Potentially inappropriate medications (PIMs) used among the elderly are a common health care challenge that can lead to increased health care costs, morbidity, and mortality. In Nigeria, several studies have evidenced a high occurrence of potentially inappropriate medication use among the elderly using Beers criteria and STOPP and START as a measuring tools [3,4,5,6]. This necessitates having health care professionals decrease the incidence by having adequate knowledge of the criteria, careful medication review, and patient education. Detailed geriatric protocols like Beers Criteria can considerably assist in the recognition of PIMs. Acquaintance with Beers Criteria among community pharmacists can consequently aid decrease prevalence of PIMs. From the best of our understanding, this is the first study in Nigeria evaluating awareness, knowledge, practice, and barriers to the use of potentially inappropriate medications and existing criteria among community pharmacists in Ibadan.
Community Pharmacists in this study had satisfactory practice with elderly patients through often questioning to evaluate the appropriateness of medications and those who were cognizant of Beers Criteria for potentially inappropriate medication had better practice than their counterparts. Approximately 50% of community pharmacists in this study do not ask for the patients' age, conflictingly most respondents conveyed they frequently contemplate their clients' age when endorsing and supplying medication. A possible justification for this inconsistency could be that community pharmacists assume their customers' age from their physical look, these results correlate with that reported in a study in Malaysia [16]. Majority of respondents from this study reported high confidence in the care they provide for the elderly which is like findings in an Italian study among physicians [20]. This can be because they use residual knowledge from pharmacy school or various other resources apart from the explicit geriatric guidelines.
This study showed that most community pharmacists in spite of encounters with a substantial quantity of elderly customers are oblivious of Beers Criteria. This finding is comparable to previous studies carried out in Malaysia among hospital, clinical pharmacists, and community pharmacists where more hospital and clinical pharmacists were more acquainted with Beers criteria than their community counterparts [8, 16]. This can be because the hospital and clinical pharmacists have a considerably greater amount of older patients with numerous comorbidities and medications and are more exposed to various parts of elderly care as part of their practice.
The knowledge score of community pharmacists in this study was unsatisfactory and community pharmacists who were cognizant of Beers Criteria had better knowledge and significantly better practice than those who were not aware signifying the need for the awareness and training of community pharmacists. This finding is like that in earlier studies which also demonstrated possible progress which might result from the improved distribution of these elderly-specific guides with regards to recognition of potentially inappropriate medications [16]. Community pharmacists with more experience had improved knowledge of potentially inappropriate medications to a certain level, this can be due to encountering a variety of elderly patients in their career. From an analysis of the individual questions, community pharmacists had satisfactory knowledge of common therapeutic areas like hypertension, diabetes, and less knowledge of psychiatry, and this can be because these are the therapeutic areas that they come across regularly and have mastered the medications used in such areas [21].
Barriers to practice listed by the community pharmacists in this study are lack of possible drug-drug interactions, price of medication to patients, inadequate understanding of potentially inappropriate medications, more time required to consult the criteria, lacking communication, and inadequate of formal education on prescribing protocols which are similar to those listed in the literature [20,21,22,23,24]. It is well established that polypharmacy is common among elderly patients in Nigeria [10] and increases the danger of potentially inappropriate prescribing, adverse drug events, and drug-drug interactions. Despite, being inevitable in elderly patients, its harmful effects can be reduced through multi-professional appraisal of the patient’s circumstance and medications, withdrawal of needless medications, and the use of precise criteria for prescribing in elderly [8, 9]. In addition to those listed in the literature, other barriers listed in the study by community pharmacists are inadequate information on patients and the inability to follow-up with patients. In Nigeria, community pharmacists do not have the means to medication archives of patients and must rely on patients' accounts which can lead to inadequate information from patients and may hinder their follow up.
This study identified the most common sources of information used by community pharmacists during their daily practice, these were reference books and software which is similar to other studies carried out among community pharmacists in Nigeria [24, 25]. In addition to those listed above, drug leaflets were also a common source of information, this can be because drug dosage information can be easily found on drug leaflets.
Overall, the findings of our report signify that although awareness of Beers Criteria was sub-optimal amid community pharmacists in Nigeria, most exhibit reasonable practice behavior while offering care to elderly customers. The limitation to this opinion was the report depended on self-responding, which might not be considered factual practice. Nonetheless, the knowledge grades detected indicate most community pharmacists exhibit sub-optimal knowledge of PIMs in the elderly, though this emphasizes the opportunity for development. Since awareness of Beers Criteria in this study was linked with better knowledge of PIMs and good practice behavior, the advantages of enhanced distribution of the elderly protocols are clear. This study was carried out in one area in Nigeria, thus there should be caution in generalization of the results.
Proposals underscoring the responsibility of community pharmacists in identifying PIMs would be beneficial but must be combined with additional recognized plans targeted at both undergraduate education and mandatory continuing professional development for practicing pharmacists [26].
Limitations of our study include reliance on community pharmacists’ reports of the use of protocols and barriers to the use of protocols. Though the Beers criteria can assist in detecting poor prescribing practices, substantial evidence to illustrate that they reliably decrease the prevalence of adverse drug events, unjustified health care resources utilization, or mortality is lacking.