Prevalence of suboptimal drug treatment in patients with and without multidose drug dispensing—a cross-sectional study

Abstract

PurposeThe aim of this study was to compare the prevalence of suboptimal drug treatment in older patients with and without multidose drug dispensing (MDD).MethodsIn 200 hip fracture patients (≥65 years of age), originally recruited to a randomized controlled study in Sahlgrenska University Hospital in 2009, quality of drug treatment at study entry was compared between patients with and without MDD. Two specialist physicians independently assessed and then agreed on the quality of the drug treatment of each patient. Suboptimal drug treatment was defined as ≥1 STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions) or ≥1 START (Screening Tool to Alert to Right Treatment) outcome assessed as clinically relevant after individual considerations had been made, i.e. over- or undertreatment (≥1 inappropriate and ≥1 missing drug, respectively).ResultsPatients with MDD (n = 100) differed from patients without MDD (n = 100) in several ways, for example by being older (87.6 vs. 81.5 years) and using more drugs (8.4 vs. 5.9 drugs). The total number (±standard deviation) of inappropriate and/or missing drugs per person was greater in MDD patients compared with patients without MDD (1.92 ± 1.52 vs. 1.06 ± 1.29, P < 0.0001); MDD patients had an additional 0.77 inappropriate drugs and an additional 0.09 missing drugs per person. The prevalence of suboptimal drug treatment was greater in patients with MDD than in those without MDD (86 vs. 55 %, P < 0.0001). Logistic regression revealed that suboptimal drug treatment was 8.0 times as common in MDD patients, after adjustments for age, sex, number of drugs, cognition, and residence (95 % confidence interval 2.4; 26.9). Corresponding figures for over- and undertreatment were 2.9 (1.1; 7.4) and 1.8 (0.8; 4.3), respectively.ConclusionsSuboptimal drug treatment, including over- and undertreatment, is more common in MDD patients than in patients who receive their drugs via ordinary prescriptions. The findings confirm safety concerns regarding quality of drug treatment in MDD patients.

Multi‐dose drug dispensing as a tool to improve medication adherence: A study in patients using vitamin K antagonists

“…The effect we found is therefore likely to be stronger for other medications. A potential disadvantage of MDD may be that MDD (when not further controlled) can lead to an increased prevalence of overmedication due to uncritical renewal of prescription . The results of this study did not show increased number of high INRs after starting MDD as compared with before, indicating that overmedication may not be a problem with respect to VKAs.…”

Do multidose compliance aids do more harm than good?

“…3,4 The same researchers reported that MCAs are associated with increased prescribing, more potentially harmful treatment, more suboptimal treatment and fewer treatment changes in both cross-sectional and longitudinal studies. 5,6 The Aberdeen study is, however, the first to describe such a high level of potentially significant drug interactions -something the authors attribute to a greater prevalence of psychotropic drug use. However, they suggest the higher use of psychotropic drugs by under-65s and 65 to 79-year-olds compared with older people may be due to a healthy survivor effect in those over 80 years old.…”

Inappropriate prescribing, non-adherence to long-term medications and related morbidities : Pharmacoepidemiological aspects

“…The association between PIPs and ADRs was investigated with a multiple logistic regression. The results were adjusted for age (65-74, 75-84, ≥85 years), sex, number of dispensed prescribed medications three months prior the study period (0, 1, 2-5, 6-9, ≥10), level of healthcare use (defined by Diagnosis-related group (DRG) weight (primary care exclusively (DRG weight=0), use of specialised inpatient or outpatient care (DRG weight>0)) (202), and use of multidose drug dispensing (203). A sensitivity analysis was performed without the 12 criteria excluded from the updated STOPP version (204).…”

“…Furthermore, in the two studies, patients prescribed multidose dispensing were excluded, because of the absence of prescribed daily doses. However, more research is needed to evaluate adherence in persons using multidose dispensing, especially with regards to concerns about the appropriate use of medications in patients using multidose dispensing (203).…”