Potentially inappropriate medications (PIMs): frequency and extent of GP-related variation in PIMs: a register-based cohort study

Abstract

ObjectivesPotentially inappropriate medications (PIMs) pose an increasing challenge in the ageing population. We aimed to assess the extent of PIMs and the prescriber-related variation in PIM prevalence.DesignNationwide register-based cohort study.SettingGeneral practice.ParticipantsThe 4.2 million adults listed with general practitioner (GP) clinics in Denmark (n=1906) in 2016.Main outcome measuresWe estimated the patients’ time with PIMs by using 29 register-operationalised STOPP criteria linking GP clinics and redeemed prescriptions. For each criterion and each GP clinic, we calculated ratios between the observed PIM time and that predicted by multivariate Poisson regressions on the patients. The observed variation was measured as the 90th/10th percentile ratios of these ratios. The extent of expectable random variation was assessed as the 90th/10th percentile ratios in randomly sampled GP populations (ie, the sampled variation). The GP-related excess variation was calculated as the ratio between the observed variation and sampled variation. The linear correlation between the observed/expected ratio for each of the criteria and the observed/expected ratio of total PIM time (for each clinic) was measured by Pearson’s rho.ResultsOverall, 294 542 individuals were exposed to 1 44 117 years of PIMs. The two most prevalent PIMs were long-term use (>3 months) of non-steroidal anti-inflammatory drugs (51 074 years of PIMs) or benzodiazepines (48 723 years of PIMs). These two criteria showed considerable excess variation of 2.33 and 3.05, respectively; for total PIMs, this figure was 1.65. For more than half of the criteria, we observed a positive correlation between the specific PIM and the sum of remaining PIMs.ConclusionsThis study documents considerable variations in the prescribing practice of GPs for certain PIMs. These findings highlight a need for exploring the causal explanations for such variations, which could be markers of suboptimal GP-prescribing strategies.

Chronic care services and variation between Danish general practices: a nationwide cohort study

“…We calculated this reference IDR by using a sampled reference population of patients from other practices (matched by sex, age, and a propensity score based on the remaining covariates). 25 Third, to estimate the association between patient characteristics and the propensity for providing services in the individual practices, we constructed a series of Poisson regression models; one for each covariateoutcome combination. The inputs were the number of observed service code outcomes for each person's practice, with a given covariate as the exposure, and the expected number of service code outcomes as the offset.…”

“…[35][36][37] Yet, to estimate excess context-related variation, it must be taken into account that some variation is expected solely due to randomness. 25 Variation may represent suboptimal treatment practices at either end of the utilisation spectrum (undertreatment or overtreatment). 12 Identifying sources of potentially inappropriate variation is difficult because variation occurs at patient level, provider level, and healthcare system level.…”

Variation in Psychometric Testing in General Practice – A Nationwide Cohort Study

“…The finding of increased variation in the provided services has also been reported in other studies, with indications that some variation is non-negligible due to derived outcomes, such as the need for immediate identification and treatment of patients at risk of suicidal behavior after the loss of a loved one. 12 , 28 , 29 …”

Geographic Variation in Top-10 Prescribed Medicines and Potentially Inappropriate Medication in Portugal: An Ecological Study of 2.2 Million Older Adults

“…Medications are considered inappropriate when the risks of their use are greater than their potential benefits or when they are prescribed in inappropriate doses and/or for unsuitable durations [10,11]. Prior studies [12][13][14] reported that in older adults, the potentially inappropriate medication (PIM) prevalence ranges from 21% to 79% according to the different health care contexts. Inappropriate drug treatment has also been associated with various adverse clinical outcomes, for instance frailty, falls, renal failure, poor physical function, impaired health-related quality of life [5,[7][8][9], higher risk of hospitalization, and mortality [12][13][14].…”

“…Prior studies [12][13][14] reported that in older adults, the potentially inappropriate medication (PIM) prevalence ranges from 21% to 79% according to the different health care contexts. Inappropriate drug treatment has also been associated with various adverse clinical outcomes, for instance frailty, falls, renal failure, poor physical function, impaired health-related quality of life [5,[7][8][9], higher risk of hospitalization, and mortality [12][13][14]. Thus, PIM leads to negative health consequences and substantial financial costs for individuals and society [5,14,15].…”