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Inappropriate prescribing in a large community‐dwelling older population: a focus on prevalence and how it relates to patient and physician characteristics
Author(s) -
Amos T. B.,
Keith S. W.,
Del Canale S.,
Orsi P.,
Maggio M.,
Baccarini S.,
Gonzi G.,
Liu M.,
Maio V.
Publication year - 2015
Publication title -
journal of clinical pharmacy and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.622
H-Index - 73
eISSN - 1365-2710
pISSN - 0269-4727
DOI - 10.1111/jcpt.12212
Subject(s) - medicine , formulary , medical prescription , logistic regression , cohort , population , retrospective cohort study , health care , family medicine , cohort study , environmental health , nursing , surgery , pathology , economics , economic growth
Summary What is known and objective The prescription of potentially inappropriate medications ( PIM s) for older adults is a well‐known population health concern. Updated country‐specific estimates of inappropriate prescribing in older adults using germane explicit criteria are needed to facilitate physician‐tailored quality improvement strategies. Therefore, we sought to determine the prevalence of PIM s for older adults in Emilia‐Romagna, Italy, using the updated Maio criteria. We also evaluated patient and general practitioner ( GP ) characteristics related to inappropriate prescribing. Methods Older adults (≥65) in 2012 were evaluated in a one‐year retrospective study using administrative health care data. The 2011 Maio criteria includes 25 medications reimbursed by the Italian National Formulary, in the following categories in terms of severity: 16 medications that ‘should always be avoided,’ 3 that are ‘rarely appropriate,’ and 6 that have ‘some indications although they are often misused.’ To evaluate the extent of associations between patient and GP related characteristics, we used generalized estimating equations with an exchangeable covariance design to fit robust logistic regression models. Results and discussion A total of 865 354 older adults were in the cohort and 28% had at least one PIM . Of the entire cohort, 8%, 10%, and 14% of individuals were prescribed at least one medication that ‘should always be avoided,’ is ‘rarely appropriate,’ and has ‘some indications but are often misused,’ respectively. Older patients (≥75) and females were more likely to be exposed to PIM s. 2,923 GP s were identified in the region, each having prescribed at least one PIM , of which older GP s (≥56), male GP s, and solo practice GP s were more likely to prescribe PIM s to their older patients. What is new and conclusion The high prevalence of PIM exposure among older adults is a substantial issue in the region. Knowing how patient and GP characteristics relate to PIM s exposure may improve the design and targeting of initiatives for improving prescribing safety in this population.