Association between recorded medication reviews in primary care and adequate drug treatment management – a cross-sectional study

Abstract

Objective: To investigate the association between a recorded procedure code for a medication review and adequate drug treatment management, and to explore factors associated with this code. Design and setting: Cross-sectional study; two primary health care centres, in Region V€ astra G€ otaland, Sweden. Subjects: A total of 302 consecutive patients (65 years old, 59% female; median number of drugs: six) requiring a non-urgent consultation with a physician in October-November 2017. Main outcome measure: Adequate drug treatment management (treatment that did not require any further action), determined in consensus by two specialists in family medicine blinded to the medication review code. Results: Adequate drug treatment management was, overall, less common in those with a recorded medication review over the last year: 63% versus 73% (p ¼ 0.047). This negative association was evident among patients aged 65-74 years: 49% versus 74% (p ¼ 0.003), but absent in those 75 years old: 67% versus 70% (p ¼ 0.77). Recommendations from consensus included the search for additional information to be able to make a decision regarding initiation or withdrawal of a drug (n ¼ 53), withdrawal of a drug (n ¼ 41), or ordering a laboratory test (n ¼ 25). Factors associated with a recorded procedure code included age above the remuneration limit of 75 years (odds ratio: 9.8; 95% confidence interval 5.0-19), type 2 diabetes (3.0 (1.5-6.2)), hypertension (2.4 (1.2-4.8)), and depression (2.5 (1.02-6.0)). Conclusions: The presence of a recorded medication review was not positively associated with adequate drug treatment management but was associated with the age limit for remuneration, and some chronic diseases. KEY POINTSTo improve drug treatment in older people in primary care, a remuneration system linked to recorded medication reviews has been introduced. In this study, fewer patients with than without a recorded medication review (63% versus 73%) had adequate drug treatment management. A recorded medication review was ten times more common in those 75 years, that is, the age limit for remuneration. Recorded codes for medication reviews were also common in those with type type 2 diabetes, hypertension, and depression.

Revisiting the inter‐rater reliability of drug treatment assessments according to the STOPP/START criteria

“…Our results diverge from those of previous reliability studies of these criteria, where the inter‐rater agreement has reportedly been strong to almost perfect among physicians 8 as well as pharmacists 11 . Below, we outline methodological differences between our study and prior ones that may explain the different estimates of reliability.…”

“…Here, we found that uncertainty regarding the drug indication was the most common reason underlying identification of PPOs by one assessor only. Furthermore, as we have previous reported, 11 the most common action suggested, when drug treatment in an older patient in primary care is considered inadequately managed, is to search for additional information in the medical records to be able to make a decision regarding the initiation or withdrawal of a specific drug. 11 Second, selecting cases specifically for the purpose of examining reliability may have implications for the assessments.…”

“…In one, the cases were selected from an RCT to represent patients with complex comorbidities and an appreciable incidence of PIMs/PPOs 8 . In the other, the cases were randomly selected from those in a study cohort that were identified to have at least one PIM or at least one PPO 11 . Therefore, the assessors could expect to find PIMs/PPOs in every patient.…”

“…Cohort I included 200 older hip fracture patients, recruited to a randomised controlled trial (RCT) in 2009 12 . Cohort II included 302 consecutive older patients requiring a planned physician consultation in either of two primary health centres over a three‐week period in 2017 11 …”

Performance of 3 Sets of Criteria for Potentially Inappropriate Prescribing in Older People to Identify Inadequate Drug Treatment

“…In this diagnostic study, we used data from 2 previous studies investigating the association between recorded medication reviews and adequacy of drug treatment, as well as the clinical relevance of PIMs/PPOs, in 302 consecutive patients aged 65 years or older attending a planned physician consultation in 1 of 2 primary care centers in 2017. 16,24 Data were obtained in October to November 2017. Data analysis was conducted from February to August 2022.…”