Association of potentially inappropriate medication use with patient and prescriber characteristics in Medicare Part D

Abstract

Purpose The use of potentially inappropriate medications (PIMs) in older people is associated with increased risk of adverse drug events and hospitalization. This study aimed to determine the contribution of primary prescribers to variation in PIM use. Methods This was a retrospective cohort study using 2008 Medicare Part D event files and claims data for a 100% sample of Texas beneficiaries. PIM use was defined as receiving any of 48 medications on the Beers 2003 list of PIMs. Patient characteristics associated with PIM use were determined using a multivariable model. A multilevel model for the odds of PIM use was constructed to evaluate the amount of variation in PIM use at the level of primary care prescriber, controlling for patient characteristics. Results Of 677,580 patients receiving prescriptions through Part D in 2008, 31.9% received a PIM. Sex, ethnicity, low-income subsidy eligibility, and hospitalization in 2007 were associated with PIM use. The strongest associations with higher PIM use were increasing number of prescribers and increasing number of medications. The odds ratio for PIM use was 1.50 (95% CI 1.47-1.53) for ≥4 prescribers versus only 1 prescriber. In the multilevel model, the adjusted average percent of patients prescribed a PIM ranged from 17.5% for the lowest decile to 28.9% for the highest decile of prescribers. Conclusions PIM use was prevalent in Part D beneficiaries and varied among individual primary care prescribers. The association of PIM use with increasing numbers of prescribers suggests the need to reduce fragmentation of care to reduce inappropriate prescribing.

Effect of Potentially Inappropriate Use of Antimuscarinic Medications on Healthcare Use and Cost in Individuals with Overactive Bladder

“…In addition, approximately 30% of members who did not meet the definition of PIM use at the time of initiation of an antimuscarinic OAB treatment had medication use or a diagnosis that would be considered indicative of PIM use after initiation of OAB antimuscarinic treatment, demonstrating the dynamic nature of medication regimens in and clinical status of this population. The prevalence of antimuscarinic PIM use in this study cohort was high but consistent with other studies of community‐dwelling elderly adults, which have identified PIM prevalence ranging from 20% to 40% . In a recent study, the prevalence of PIM use in a general sample of Medicare Advantage Prescription Drug beneficiaries was 31.9% .…”

“…To minimize PIM use, providers should consider medical history and concurrent medication use when initiating OAB medication treatment. PIM use is generally associated with more prescribers being involved in an individual's care and more medications being taken . In clinical situations in which cognitive impairment may be intrinsic to the presentation, the patient may not be a reliable informant of current or past medication history.…”

Diabetes Mellitus Care Provided by Nurse Practitioners vs Primary Care Physicians

“…The rate of use of PIMs was close to that in a previous study . Some of these medications prolong hypoglycemia in individuals with diabetes mellitus.…”

Potentially inappropriate medications use in community-based aged patients: a cross-sectional study using 2012 Beers criteria

“…Moreover, the prevalence in different populations may vary according to the time and place of data gathering 13. As such, factors like ethnicity, economic incomes, and duration of data gathering may also contribute toward the differences 27,28…”