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National outpatient medication profiling: medications associated with outpatient fractures in community‐dwelling elderly veterans
Author(s) -
French Dustin D.,
Campbell Robert,
Spehar Andrea,
Rubenstein Laurence Z.,
Branch Laurence G.,
Cunningham Francesca
Publication year - 2007
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.1365-2125.2006.02798.x
Subject(s) - medicine , profiling (computer programming) , outpatient clinic , emergency medicine , gerontology , computer science , operating system
What is already known about this subject • Polypharmacy, to include a subissue of potentially inappropriate prescribing, in community‐dwelling elderly is widespread. • The objective of this study was to identify the magnitude of problematic outpatient drug prescribing and its potential association as a risk factor for injuries. What this study adds • This is the first national study of outpatient injuries in elderly veterans. • The results are consistent with previous published literature highlighting the risks associated with prescribing central nervous system drugs in the elderly. Aims The primary objective of this retrospective case–control study in an elderly veteran population was to assess the impact of specific medications with recognized side‐effects that increase the risk of a fall and were prescribed prior to fractures treated in the outpatient setting compared with patients treated for nonspecific chest pain. Methods Two national Veterans Health Administration (VHA) databases were used to identify 17 273 unique patients, aged ≥65 years, treated in outpatient settings with a fracture in fiscal year 2005, and for whom we could link to all of their outpatient prescriptions (809 536). For comparison, we identified other elderly patients with outpatient clinic visits for nonspecific chest pain ( N = 62 331) for whom we could link with their 2 987 394 outpatient prescriptions. We categorized the fall‐related medications as drugs that primarily affect the cardiovascular (CVS), the central nervous (CNS) or the muscular skeletal system (MSS). Results Significant differences in the two patient groups occurred in the CNS category. Approximately 41% of the patients with fracture‐coded encounters were prescribed CNS drugs compared with 31% of the patients in the comparison group ( P < 0.0003). Finally, the use of muscle relaxants in the MSS category was significantly higher in the fracture group than in the nonspecific chest pain group. Conclusions Studies using administrative data can foster the development of more proactive pharmacovigilance systems and assist in formulary refinement, particularly in countries with national healthcare systems that have integrated patient data. Particular attention and monitoring of elderly patients taking CNS medications may be important for injury prevention.