Prescribing Renally Inappropriate Medication to Hospitalized Geriatric Patients in Makkah, Saudi Arabia

Hamsah S Alqashqri,1 Ahmed Siddiqi,2 Halah T Albar,3 Enas H Alfalogy,1,4 Nahla H Hariri,1 Yosra Z Alhindi,5 Asim M Alshanberi,1 Safaa M Alsanosi,5 Alaa H Falemban5 1Department of Community Medicine and Pilgrims Health Care, Faculty of Medicine, Umm Al Qura University, Makkah, Saudi Arabia; 2Department of Internal Medicine, National Guard Hospital, Jeddah, Saudi Arabia; 3Department of Physiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia; 4Family Medicine, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt; 5Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al Qura University, Makkah, Saudi ArabiaCorrespondence: Alaa H Falemban, Email [email protected]: As a result of the physiological decline in renal function that comes with age and the common failure to recognise renal insufficiency, older adults aged 65 and above are at increased risk of receiving medications that are inappropriate for their level of renal function which in turn lead to increased risk of adverse effects. Little is known about how many older adults receive medications that are inappropriate for their level of renal function. This study aimed to determine the prevalence of renally inappropriate medications in elderly adults by reviewing patient files and evaluating the appropriateness of medication doses relative to renal function in patients aged ≥ 65 years at inpatient healthcare departments.Methods: A retrospective cross-sectional study of patients aged ≥ 65 years was conducted, covering cases from 2015 to 2021. Patient’s medical records were reviewed, their renal function and medications lists were evaluated, determined whether they had been prescribed at least one renally inappropriate medication based on drug-dosing recommendations for different degrees of renal function.Results: A total of 317 elderly inpatients were included, 10% of whom had received inappropriate doses relative to their renal function. Glomerular filtration rate was associated with inappropriate dosing in this study. Of the patients CKD stage 5, 36.8% had at least one drug administered at an inappropriate dose, while this figure was 6.5% among the patients at CKD stage 1; this difference was statistically significant (p = 0.001).Conclusion: A notable portion of older adults may be at risk of adverse effects due to inappropriate medication dosing related to their renal function. Further studies with large samples, drug use analyses based on comprehensive geriatric references and a prioritisation of actual outcomes over potential outcomes are needed to further determine elderly adults’ exposure to inappropriate drugs.Keywords: older adults, geriatric, inappropriate medication, healthcare outcomes, elderly inpatients, renally inappropriate medication, physiological decline, healthcare evaluation, insufficienc

Emergency Physicians’ Knowledge, Attitudes, and Practices Related to Psychiatric Emergencies in Makkah’s General Hospitals in Saudi Arabia: A Cross-Sectional Study

Raghad M Ali,1 Abdulkarim A Aljabri,1 Nahla H Hariri,2 Ghadi S Bokhari,1 Shahad A Alturkistani,1 Nidaa A Albishri,1 Hamza A Alzahrani,1 Shuruq A Alghamdi,3 Renad T Alhazmi,1 Enas H Alfalogy2,4 1College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia; 2Community Medicine and Pilgrims Healthcare Department, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia; 3Directorate of Health Affairs, Eradah Complex for Mental Health, Jeddah, Saudi Arabia; 4Family Medicine Department, Faculty of Medicine, Suez -Canal University, Ismalia, EgyptCorrespondence: Nahla H Hariri, Community Medicine and Pilgrims Healthcare Department, College of Medicine, Umm Al-Qura University, Makkah, 21955, Saudi Arabia, Email [email protected]: This study aims to assess the knowledge, attitudes, and practices of emergency physicians (EPs) related to psychiatric emergencies (PEs) in Makkah’s general hospitals.Sample and Methods: This study was an observational cross-sectional study using an online survey distributed to 138 EPs in the emergency departments (EDs) of six public hospitals in Makkah City, Saudi Arabia, between March 15 and May 1, 2023. A convenience sample was used for data collection. The questionnaire was developed after related surveys in the literature were reviewed.Results: 59.9% of the physicians were aged 20– 30 years. Most (68.8%) worked in hospitals that had psychiatric facilities. Regarding knowledge, only 30% of the emergency doctors were considered knowledgeable: the majority could identify PEs (79.7%), perform mental status examinations (71.0%), distinguish physical and mental symptoms (66.7%), and communicate with psychiatric patients (58.0%). However, only 52.9% could initiate management plans by prescribing psychiatric medication to patients. In relation to attitude, most physicians disagreed with the idea that healthcare practitioners do not need to advocate for psychiatric patients (67.4%), but many (62.3%) assumed that they do not have the responsibility to manage psychiatric patients, and they felt that conducting psychiatric evaluations in public hospitals is challenging because of the busy environment there. As regards practice, mentally ill patients (60.9%) were managed or referred by practices, and 56.5% of the EPs advised these patients upon discharge.Conclusion: The study showed that EPs have positive attitudes toward psychiatric patients, but their knowledge varied based on age, occupation levels, and years of experience. There were significant knowledge gaps, particularly regarding effective communication with psychiatric patients. Additionally, many EPs manage psychiatric patients without being aware of the psychiatric resources in their hospital. Improving medical school curricula and postgraduate training can enhance care. However, more research in this field is needed.Keywords: emergency departments, psychiatric patients, public hospitals, mental status examinatio