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Development of prescribing indicators for elderly medical inpatients
Author(s) -
Oborne C. Alice,
Batty Gwenno M.,
Maskrey Vivienne,
Swift C. G.,
Jackson S. H. D.
Publication year - 1997
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/j.1365-2125.1997.tb00143.x
Subject(s) - medicine , medical prescription , psychological intervention , medical record , warfarin , aspirin , polypharmacy , digoxin , atrial fibrillation , emergency medicine , pediatrics , pharmacology , heart failure , psychiatry
Aims To identie and improve suboptimal prescribing for elderly patients we have developed a number of prescribing indicators which focus on areas of concern and allow evaluation of the benefit of interventions. We report here on fourteen indcators. Methods The indicators are of three types: a) purely descriptive with no attempt to define optimal values, e.g. number of items prescribed per patient; b) based on unnecessary or potentially harmful prescribing, e.g. duplication; c) assessing the appropriateness of prescribing specific drugs or combinations e.g. digoxin and warfarin/aspirin in atrial fibrillation (AF). Appropriateness was defined on the basis of objective research findings and involved comparing individual patient clinical records to criteria for appropriate prescribing. Prescribing and personal data were collected for medical inpatients aged 65 years or over in 19 hospitals in England and Wales. A total of 1686 patients were included, median age 81 years, 41% were male. Results Patients were prescribed 11 475 items, mean 4.6 regular items per patient. Completion of drug allergy/sensitivity statements varied from 3 to 93% between units. Use of generic name and specification of a maximum frequency of administration for‘as required’medicines were more consistent, ranging from 76–94% and 52–81% respectively. Little duplication of therapy was seen. Benzohazepines were prescribed for 22% patients, but were appropriate in only approximately one third of these. Of the 2% patients prescribed an angiotensin convecting enzyme inhibitor with a potassium‐sparing diuretic or potassium supplement, prescription of the combination was appropriate in 84%. Coprescription of steroids with β 2 ‐adrenoceptor agonists appeared excessive in 67% patients receiving a β 2 ‐adrenoceptor agonist, as only 51% had documented evidence of steroid responsiveness or another indication for steroids. Stroke prophylaxis in AF was inadequate: 22% patients prescribed digoxin also received warfarin or aspirin 300 mg whereas 64% should have received the coprescription. Conclusions These prescribing indicators are sensitive to inappropriate prescribing for elderly medical inpatients and cover a wide range of therapeutic areas. They should enable changes in prescribing quality to be measured objectively. Interhospital variation in casemix resulted in substantial differences in the proportion of patients in whom it would have been appropriate to prescribe specific drugs or combinations and prevented derivation of reference ranges of optimal prescribing for four indicators.