Potentially inappropriate medication use in hospitalized elders

Abstract

BACKGROUND: Prescribing of potentially harmful medications has not been well documented in hospitals. OBJECTIVE: The objective of the study was to determine the rate of and factors associated with potentially inappropriate medication (PIM) prescribing in a large inpatient sample. DESIGN: The study was a retrospective cohort of the period between September 1, 2002, and June 30, 2005. We used multivariable logistic regression to identify patient, physician, and hospital characteristics associated with PIM prescribing. SETTING: The study collected data from 384 US hospitals. PATIENTS: The sample was composed of patients aged ≥65 years admitted with 1 or more of 7 common medical diagnoses. MEASUREMENTS: The percentage of patients prescribed PIMs as defined using a modified Beers list was measured. Multivariable‐adjusted odds ratios for PIM use were computed. RESULTS: Of the 493,971 patients, 49% received at least 1 PIM, and 6% received 3 or more, most commonly promethazine, diphenhydramine, and propoxyphene. Patient, physician, and hospital characteristics were all associated with PIM use. Patients with myocardial infarction or heart failure were most likely (61% and 52% vs. 46% for pneumonia), men (47% vs. 49% for women) and those in managed care plans (44% vs. 49% for other plans) were less likely, and patients ≥85 years were least likely (42% vs. 53% for patients aged 65–74 years) to receive PIMs (P < .0001 for all comparisons). For high‐severity PIMs, internists and hospitalists had similar prescribing rates (33%), cardiologists had a higher rate (48%), and geriatricians had the lowest rate (24%). The proportion of elders receiving PIMs ranged from 34% in the Northeast to 55% in the South, and variation at the individual hospital level was extreme. At 7 hospitals, PIMs were never prescribed. CONCLUSIONS: Wide variation in the use of PIMs is associated with hospital and physician characteristics. Care may be improved by minimizing this non‐patient‐centered variation. Journal of Hospital Medicine 2008;3:91–102. © 2008 Society of Hospital Medicine.

Potentially Inappropriate Medication Use Among Older Hospitalized Patients in a Brazilian General Hospital

“…The prevalence of prescription of PIMs independent of diagnoses or condition (59.3%) was higher than that reported in other studies employing similar methods (14,16,17,26,28) The high frequency of prescription of PIMs may reflect the lack of knowledge regarding the Beers Criteria among prescribers. This reinforces the importance of the dissemination of the Beers Criteria among physicians, and the implementation of prescription review.…”

“…In other studies, PIM use was associated with female gender, (14,26), admission for cardiovascular disease (14), and younger age groups (14,16).…”

“…Also, in geriatric prescribing, combinations of medicines which cause drug interactions, fixed combinations, dual therapy, and drugs with questionable therapeutic value should all be avoided (9)(10)(11).The quality of drugs prescription for the elderly may, therefore, be assessed by different indicators. In pharmacoepidemiological studies targeting hospitalized elderly, evaluation of parameters such as the use of potentially inappropriate medication (PIM) and polypharmacy is common (8,(12)(13)(14)(15)(16)(17).…”

Comparative effectiveness of low‐molecular‐weight heparin versus unfractionated heparin for thromboembolism prophylaxis for medical patients

“…10 Compared to US hospitals as a whole, Perspective hospitals are more likely to be located in the South and in urban areas. Perspective contains the following data elements: sociodemographic information, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis and procedure codes, as well as a list of all billed items with a date of service, including diagnostic tests, medications, and other treatments.…”

Inappropriate prescribing in hospitalized elderly patients

“…It ranges from 14.6% to 91.9%. [33][34][35][36][37][38][39][40] This difference relates to the several methodological aspects used. The highest prevalence of overall IP was found by Hanlon et al (91.9%).…”