Pharmacologically inappropriate prescriptions for elderly patients in general practice: How common?

Brekke, Mette; Rognstad, Sture; Straand, Jørúnd; Furu, Kari; Gjelstad, Svein; Bjørner, Trine; Dalen, Ingvild

doi:10.1080/02813430802002875

Cited by 54 publications

(65 citation statements)

References 27 publications

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“…The proposal is based on Swedish recommendations, internationally published explicit criteria and expert opinions. This indicator has been used in several research studies [9,[18][19][20][21][22][23] as well as in recent national assessments of quality and efficiency in the Swedish healthcare system [24]. The indicator is considered to be a proxy for polypharmacy (concurrent use of multiple drugs) and to signal poor quality in the treatment of psychiatric disorders.…”

Section: Introductionmentioning

confidence: 99%

“…The development of explicit criteria for measuring the use of potentially inappropriate drugs among the elderly, such as Beers' criteria, has primarily occurred in North America [4][5][6][7], but also in other countries [8][9][10]. The usefulness of such criteria depends on the availability of drugs and prescribing patterns, and they are therefore not easily transferable between countries.…”

Section: Introductionmentioning

confidence: 99%

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To what extent does the indicator “concurrent use of three or more psychotropic drugs” capture use of potentially inappropriate psychotropics among the elderly?

Lesén

Petzold

Andersson

et al. 2009

Eur J Clin Pharmacol

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Purpose The indicator "concurrent use of three or more psychotropic drugs" has been used as a measure of quality in drug use among the elderly. The aim of our study was to assess to what extent the indicator captures the use of specific psychotropics associated with an increased risk of adverse events among the elderly, i.e., potentially inappropriate psychotropic drugs (PIP). Methods All individuals aged 75 years and older in Sweden purchasing prescribed psychotropic drugs in 2006 constituted the study population (n=384,904). Data on purchased psychotropic drugs from the Swedish Prescribed Drug Register were used. The overlap between individuals with the indicator and individuals using PIP was assessed with sensitivity, specificity, positive and negative predictive values and likelihood ratio as outcome measures. Results Among the psychotropic drug users, 15% had the indicator and 39% used PIP. The proportion of individuals with the indicator among all individuals using PIP was 27% (sensitivity). The proportion of individuals without the indicator among all individuals not using PIP was 93% (specificity). The positive predictive value was 72%, and the negative predictive value was 67%. Differences in outcome measures were observed between different categories of PIP. Conclusions The indicator "concurrent use of three or more psychotropics" can be technically easy to use, but PIP is more specific. Three quarters of all individuals who used PIP in this study were not captured by the indicator.However, two thirds of all individuals with the indicator used PIP. When selecting instruments to assess appropriateness in drug therapy in the elderly, clinical relevance should be balanced against convenience of use.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

To what extent does the indicator “concurrent use of three or more psychotropic drugs” capture use of potentially inappropriate psychotropics among the elderly?

Lesén

Petzold

Andersson

et al. 2009

Eur J Clin Pharmacol

View full text Add to dashboard Cite

show abstract

“…Este fenómeno originou um aumento da prevalência das doenças crónicas e do número de indivíduos polimedicados, realidade mais evidente na população idosa. [3][4][5][6][7][8][11][12][13][14][15][16][17][18] A adesão à terapêutica é menor em indivíduos portadores de doenças crónicas devido à necessidade de medicação prolongada 19 e também naqueles com esquemas terapêuticos complexos, isto é, com múltiplos fármacos ou tomas. 3,7,11 Este tipo de esquemas não só diminui a adesão à terapêutica, como também aumenta o risco de erros de medicação; risco todavia maior quando associado às alterações fisiológicas do envelhecimento.…”

Section: Introductionunclassified

“…3,7,11 Este tipo de esquemas não só diminui a adesão à terapêutica, como também aumenta o risco de erros de medicação; risco todavia maior quando associado às alterações fisiológicas do envelhecimento. [4][5][6][11][12][13]15,19 Os sistemas eletrónicos de informação e decisão terapêutica e a informação escrita são fatores que contribuem para minimizar os erros de prescrição e favorecem a adesão à medicação, melhorando a prestação de cuidados e contribuindo para a redução de custos. [3][4][5][6][7][8][9][10] Por tudo o que foi referido, surgiu a necessidade de conhecer a realidade portuguesa em relação ao registo da medicação prolongada, para que se possam implementar medidas para melhorar a prestação de cuidados, minimizar os erros de prescrição e os custos nos cuidados de saúde.…”

Section: Introductionunclassified

Avaliação da Qualidade dos Registos de Medicação Prolongada: Estudo QMP

et al. 2014

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Introduction:The growing concern surrounding health safety issues makes it essential that everyone, in particular the elderly due to their commonly prescribed multiple drugs, has a complete and up to date list of prescriptions. We planned to assess the quality of the electronic records of prolonged medication. Material and Methods:This is an observational, transversal and descriptive study, with an analytical component, in which we assessed the technical quality of prolonged medication records of elderly patients of four primary health care, before and after a guided intervention. The doctors received training in good practice recording methods and both professionals and patients were stimulated to use the prolonged medication guide. Results: We evaluated 388 medical records of 33 physicians. The ideal category 'Appropriated medication with posology' improved from 23.5% to 48% (p < 0,001). The remaining categories 'Inappropriated Medication' and 'Appropriated medication but absent posology' decreased from 16.7% to 7% (p = 0,006) and from 59.8% to 46.0% (p = 0,02), respectively. The variables mentor's training skills, workplace, length of family practice and the percentage of elderly in the physician's list showed statistical significance differences at the beginning of the study which disappeared after the intervention, except for the latter. Discussion: In this study, physicians accepted the proposed changes, regardless of age, gender, mentor's training skills, workplace or length of family practice. Longer duration appointments in the eldery group may be an obstacle in achieving the best results. Conclusion: This original study reveals the necessity to implement periodic postgraduate training to encourage physicians to keep medical records up to date.

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“…A fraction of these treatments may have been initiated by hospital clinics or specialists, but the continued control of the treatments is largely the responsibility of the GP. Sometimes an ongoing treatment may prove not to be appropriate any more regardless of the time and place of initiation [5,6]. The decision to stop treatment most often has to be taken by the GP.…”

Section: When To Stop?mentioning

confidence: 99%

When to stop?

Zwisler

Larsen

Gram

2009

Scandinavian Journal of Primary Health Care

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Pharmacologically inappropriate prescriptions for elderly patients in general practice: How common?

Abstract: The study reveals areas where GPs' prescribing practice for elderly patients can be improved and which can be targeted in educational interventions.

Cited by 54 publications

References 27 publications

To what extent does the indicator “concurrent use of three or more psychotropic drugs” capture use of potentially inappropriate psychotropics among the elderly?

To what extent does the indicator “concurrent use of three or more psychotropic drugs” capture use of potentially inappropriate psychotropics among the elderly?

Avaliação da Qualidade dos Registos de Medicação Prolongada: Estudo QMP

When to stop?

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