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Potentially inappropriate prescribing and adverse health outcomes in community dwelling older patients
Author(s) -
Cahir Caitriona,
Bennett Kathleen,
Teljeur Conor,
Fahey Tom
Publication year - 2014
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.12161
Subject(s) - medicine , adverse effect , polypharmacy , medline , gerontology , intensive care medicine , political science , law
Aims This study aimed to determine the association between potentially inappropriate prescribing ( PIP ) and health related outcomes [adverse drug events ( ADEs ), health related quality of life ( HRQOL ) and hospital accident and emergency ( A&E ) visits] in older community dwelling patients. Methods A retrospective cohort study of 931 community dwelling patients aged ≥70 years in 15 general practices in I reland in 2010. PIP was defined by the S creening T ool of O lder P erson's P rescriptions ( STOPP ). ADEs were measured by patient self‐report and medical record for the previous 6 months and reviewed by two independent clinicians. HRQOL was measured by the EQ ‐ 5D . A&E visits were measured by patients’ medical records and self‐report. Multilevel logistic, linear and Poisson regression examined how ADEs , HRQOL and A&E visits varied by PIP after adjusting for patient and practice level covariates: socioeconomic status, co‐morbidity, number of drug classes and adherence. Results The overall prevalence of PIP was 42% ( n = 377). Patients with ≥2 PIP indicators were twice as likely to have an ADE (adjusted OR 2.21; 95% CI 1.02, 4.83, P < 0.05), have a significantly lower mean HRQOL utility (adjusted coefficient −0.09, SE 0.02, P < 0.001) and nearly a two‐fold increased risk in the expected rate of A&E visits (adjusted IRR 1.85; 95% CI 1.32, 2.58, P < 0.001). The number of drug classes and adherence were also significantly associated with these same adverse health outcomes. Conclusions Reducing PIP in primary care may help lower the burden of ADEs , its associated health care use and costs and enhance quality of life in older patients.