DETERMINANTS OF PRESCRIBING FOR THE ELDERLY IN PRIMARY HEALTH CARE

Authors:
Dr. Mohammed H. AL - Doghether ABFM, SBFM
Center of post graduate studies in family medicine, Riyadh, Saudi Arabia.
Dr. Tarek I. AL - Megbil ABFM, SBFM 
Department of primary health care, Riyadh region, Ministry of Health. Saudi Arabia.

Corresponding author:
DR. Mohammed H. AL - Doghether, Center of post graduate studies in family medicine.
P.O.Box 90945
Riyadh 11623, Saudi Arabia.
E-mail: doghether@hotmail.com
Fax : +96614970847
Phone: +96614970468

ABSTRACT
Objectives: - To evaluate determinants of prescribing for the elderly in primary care such as diagnoses types, sources and availability of medications.
Design: - Cross sectional study of elderly patients in primary care.
Setting / Institution: -Training primary care center in Riyadh (AL Rabwah primary care center)
Subjects: - 100 elderly patients randomly selected from Rabwah primary care center 
Main Measures: - Number of concomitant diseases, diagnoses, number, types and sources of medications for elderly in primary care.
Results: - The study showed 51% of patients are being followed up in primary care center, 56% of patients had two and more diseases, and 31% of patients are on three or more medications. 61% of patients get their medications form primary care center and 95% of elderly medications may be available in primary care center. 
Conclusions: - Most of elderly patients depend on primary care center for their health care.
Well-organized elderly care system need to be in effect urgently in primary care settings coupled with appropriate educational programs for the health care team members.

Key words: Health, Prescribing, Elderly, primary care.

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Introduction:
The global increase in people aged 60 years and above had attracted the attention of the world to the magnitude of the problems of providing health care for the elderly(1) . The proportion of geriatric population in developed countries reached between 12 and 18% of total population and expected to increase in coming years(2,3), a phenomenon known as the "baby boomers" in the west. Similar changes noticed in developing countries(4), and Saudi Arabia is not an exception. In Saudi Arabia studies on general population in primary health care PHC showed an average of 3.2 0.04 drugs per prescription and an average of 1.8 0.3 drugs per patient. Higher numbers are expected to be found in the elderly population which composes about 20.7% of patients attending PHC (5.6) .

Traditional teaching suggests that a prescription should be safe, necessary, effective and economical. 

Since increasing number of elderly patients, a group with special medical needs, will be seen in PHC, the objective of the present study was conducted to evaluate the essential drugs list available now (7) taking into consideration the needs of this age group. 

Subjects and methods: 
This is a cross sectional study that was conducted in Riyadh. During April-July 2001.

The study population was elderly patients aged 60 years and above, who were registered in a training (Rabwah) primary health care (PHC) center. 

A pilot study was conducted in King Fahad PHC center and relevant changes in questionnaire were made after ward. The final questionnaire completed included the following: -

1. Demographic data such as age, gender, level of education and place for follow up of disease. 

2. Health variables such as number of concomitant diseases, diagnoses, number, types, sources and availability of medications used by patient, whether patient is using any medical appliances and information related to it, i.e. devices like diabetes kits.