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    POLYPHARMACY PREVALENCE AMONG GERIATRIC PATIENTS IN PRIMARY HEALTHCARE SETTINGS ACROSS TURKEY: A CROSS-SECTIONAL ANALYSIS THROUGH THE NATIONWIDE PRESCRIPTION INFORMATION SYSTEM
    (2020) Aydos, ToIga Resat; Emre Aydingoz, Selda; Lux, Karl Michael; Efe, Oguzhan Ekin; Isli, Fatma; Aksoy, Mesil; Kadidoi, Esma; 0000-0002-3243-7843; 0000-0002-1832-9336; 0000-0001-7823-7620; W-7908-2019; AAJ-7279-2020; ABA-4291-2020
    Introduction: Polypharmacy has become a common health problem as populations age. We aimed to determine the prevalence of chronic and cumulative polypharmacy in the geriatric population using primary healthcare services in Turkey. Materials and Methods: The electronic prescriptions ordered by family physicians across Turkey for geriatric patients (>= 6.5 years) in the Prescription Information System during 2018 were studied. Chronic polypharmacy criteria were proportion of patients who were given prescriptions containing >= 5 drugs four or more times during a year. Cumulative polypharmacy was defined as proportion of patients who were prescribed >= 5 drugs with different ATC4 codes in a month or in each quarter of the year. Results: Turkey's total population is 82 million; 7,186,204 are aged 65 and over, constituting 8.8% of the total. Of this geriatric population, 6,104,798 (85.0%) had at least one prescription in 2018. Each geriatric patient had 6.4 prescriptions, with each prescription containing an average of 2.9 drugs with different fourth-level Anatomical Therapeutic Chemical codes. Each drug was prescribed in 2.7 boxes on average. Of these prescribed patients, 14.3% received prescriptions containing >= 5 drugs four or more times during 2018. The percentage of patients who received at least one prescription per month containing >= 5 drugs ranged between 16.4% and 20.7%. The most commonly prescribed drugs were acetylsalicylic acid, diclofenac, paracetamol, and pantoprazole. Conclusion: Polypharmacy is a critical health problem among geriatric population in Turkey as in other industrialized countries. Educating physicians as well as the public is essential to overcome polypharmacy.
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    Relative risk of tuberculosis in patients with rheumatic diseases managed with anti-tumour necrosis factor-alpha therapy: A nationwide cohort study
    (2019) Aydin, Volkan; Akici, Ahmet; Isil, Fatma; Aksoy, Mesil; Aydin, Mehtap; Gursoz, Hakki; 30763469
    What is known and objective Anti-tumour necrosis factor-alpha (anti-TNF-alpha) therapy is known to raise the risk of granulomatous infections, leading to development of risk management strategies at national or global level. This study aimed to determine the relative risk (RR) of tuberculosis (TB) due to anti-TNF-alpha usage in patients with rheumatologic diseases (RDs) in a nationwide basis. Method This retrospective cohort study included patients with rheumatoid arthritis (RA), ankylosing spondylitis, juvenile idiopathic arthritis or psoriatic arthritis (PsA) that treated with or without anti-TNF-alpha agents, as registered in the national prescription information system between years 2013 and 2015. Two-year RR of TB after anti-TNF-alpha therapy initiation was calculated in this RD population, including main subgroups. Results and discussion The study cohort included 413 500 RD patients, where anti-TNF-alpha(+) arm (n = 2117) had mean age of 41.9 +/- 13.4 years and male distribution of 54.3%. Four patients among anti-TNF-alpha users developed TB compared to 128 patients in anti-TNF-alpha-naive group (189 vs 31 cases per 100 000 patients, respectively), yielding a 2-year RR of 6.07 (95% CI, 2.25-16.42) with an attributable risk of 0.16%. These RRs (95% CI), which were particularly pronounced, were 5.39 (1.69-7.17) in men, 6.12 (2.26-16.55) in adults, and 5.70 (1.41-23.08) in RA and 13.46 (1.58-114.40) in PsA patients. There was no difference between the anti-TNF-alpha users who developed and undeveloped TB regarding drug utilization characteristics, except significantly less immunosuppressive drug exposure in TB patients. What is new and conclusion This study is the first prescription-based nationwide study to suggest an elevated RR of TB in a comparably younger population with a broad spectrum of RDs managed with any approved anti-TNF-alpha drug in Turkey.