Factors associated with potentially inappropriate prescriptions and barriers to medicines optimisation among older adults in primary care settings: a systematic review

Abstract

ObjectiveTo identify factors that likely contribute to potentially inappropriate prescriptions (PIPs) among older adults in primary care settings, as well as barriers to medicines optimisation and recommended potential solutions.DesignSystematic review.Eligibility criteriaQuantitative studies that analysed the factors associated with PIPs among older adults (≥65 years) in primary care settings, and qualitative studies that explored perceived barriers and potential solutions to medicines optimisation for this population.Information sourcesPubMed, EMBASE, Scopus, CINAHL, PsycINFO, Web of Science, CNKI and Wanfang.ResultsOf the 13 167 studies identified, 50 were included (14 qualitative, 34 cross-sectional and 2 cohort). Nearly all quantitative studies examined patient-related non-clinical factors (eg, age) and clinical factors (eg, number of medications) and nine studies examined prescriber-related factors (eg, physician age). A greater number of medications were identified as positively associated with PIPs in 25 quantitative studies, and a higher number of comorbidities, physical comorbidities and psychiatric comorbidities were identified as patient-related clinical risk factors for PIPs. However, other factors showed inconsistent associations with the PIPs. Barriers to medicines optimisation emerged within four analytical themes: prescriber related (eg, inadequate knowledge, concerns of adverse consequences, clinical inertia, lack of communication), patient related (eg, limited understanding, patient non-adherence, drug dependency), environment related (eg, lack of integrated care, insufficient investment, time constraints) and technology related (eg, complexity of implementation and inapplicable guidance). Recommended potential solutions were based on each theme of the barriers identified accordingly (eg, prescriber-related factors: incorporating training courses into continuing medical education).ConclusionsOlder adults with more drugs prescribed and comorbidities may have a greater risk of receiving PIPs in the primary care setting, but it remains unclear whether other factors are related. Barriers to medicines optimisation among primary care older adults comprise multiple factors, and evidence-based and targeted interventions are needed to address these difficulties.PROSPERO registration numberCRD42020216258.

Primary care physician responses to requests by older adults for unnecessary drugs: a qualitative study

“…Pharmacists play an important role in assessing prescription and pharmaceutical care, such as medication counselling and medicine reviews [35][36][37]. They also have opportunities to work closely with PCPs to address medication management challenges [38,39]. For example, an older adult could be referred to the pharmacist for consultation if a PCP had difficulties with an explanation.…”

Evidence for Assessing Drug Safety and Drug Use in Older People

“…Many studies (Oliveira et al, 2012;Shah and Hajjar, 2012;Khatter et al, 2021;Xu et al, 2021) point out that polypharmacy is a risk factor for PIM, particularly for older patients. The more medications a patient are taking, the more likely they are to have an adverse drug event (ADE), potentially experience a drug-drug interaction, take a PIM, or be non-compliant to one or more of the medications prescribed (Shah and Hajjar, 2012) In recent years, several strategies and tools have been developed to identify the inappropriate prescribing of medications.…”

Impact of the publication of the Finnish Meds75+ database on the use of potentially inappropriate medications in older persons

“…In particular, a high number of comorbidities and polypharmacies are major risk factors for PIM use. 10,11 The prevalence is dependent on the criteria used and the study setting. According to a systematic review by Morin et al, 12 the overall prevalence of PIMs was 49.8% according to several criteria among nursing home residents in studies conducted in different countries from Europe, Asia, Australia and North America between 2006 and 2014.…”