Potentially inappropriate medication use by level of polypharmacy among US Veterans 49–64 and 65–70 years old

Abstract

Background Potentially inappropriate medications (PIMs) are medications contra‐indicated in particular circumstances. We sought to characterize PIMs by level of polypharmacy by age, sex, and race/ethnicity. Methods We performed a cross‐sectional drug dispensing study using electronic health records available through the US Department of Veterans Affairs. We extracted pharmacy fill and refill records during fiscal year 2016 (i.e., October 1, 2015–September 30, 2016) for all patients aged 49–70 who accessed care in the preceding fiscal year. PIMs were defined by the combined Beers and Laroche (henceforth Beers Laroche) criteria used for older patients and the PROMPT criteria used for middle‐aged. Results In the 1 499 586 patients aged 49–64, PIMs prevalence by PROMPT in patients with 0–4, 5–9, and ≥10 medications was 14.0%, 62.2%, and 86.1%, respectively, and by Beers Laroche was 14.3%, 63.4%, and 85.7%, respectively. In the 1 249 119 patients aged 65–70, PIMs prevalence by Beers Laroche was 14.8%, 59.9%, and 83.3%, and by PROMPT was 13.9%, 57.4%, and 82.0%, respectively. Meaningful differences in prevalence were shown by sex and race/ethnicity according to both set of criteria (e.g. PROMPT in patients with 5–9 medications: 66.1% women vs. 59.3% men; standardized‐mean‐differences [SMD] = 0.14; 61.7% of White vs. 54.5% of non‐White; SMD = 0.15). The most common PIMs were digestive, analgesic, antidiabetic, and psychotropic medications. Conclusion Prevalence of PIMs was high and increased with polypharmacy. Beers Laroche and PROMPT provided similar estimations inside and outside their target age, suggesting that PIMs are common among those with polypharmacy regardless of age.

Identifying Longitudinal CD4:CD8 Ratio Trajectories Indicative of Chronic Renal Disease Risk among People Living with HIV: An Application of Growth Mixture Models

“…The complex process of aging, while living with HIV, presents many challenges for patients and healthcare providers, due to different psychosocial (e.g., social isolation), structural (e.g., access to healthcare resources, housing, food, and medications), and behavioral factors (e.g., substance use), and the cumulative toxicity of HIV/non-HIV medications increasing the complexity in the clinical management of individuals with multimorbidity [ 4 ]. Studies have shown that the management of individuals who present with a large number of medical issues can be quite complex, increasing the risk of polypharmacy and drug–drug interactions [ 5 , 6 , 7 , 8 ]. Since services and programs for PLWH with multimorbidity in different settings can be highly disconnected, they are inefficient in adequately achieving those who need care, adding to the complexity in the clinical management of these individuals.…”