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

Abstract

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.

Prognostic value of the quality indicator “concurrent use of three or more psychotropic drugs” among residents of long-term care facilities: a comment

“…The findings by Bell et al complement our previous research in which we assessed the extent to which the indicator captured use of potentially inappropriate psychotropic drugs (PIP) among the elderly [3]. We found that only one quarter of those using PIP had the indicator and concluded that clinical relevance should be balanced against convenience of use when selecting instruments to assess appropriateness in drug therapy in the elderly.…”

“…We found that 72% of individuals with the indicator used PIP [3]. Thus, if a scan for specific drugs or combinations is unfeasible in quality assessments, the indicator may serve as a crude screening tool for inappropriate drug use.…”

Socioeconomic determinants of psychotropic drug utilisation among elderly: a national population-based cross-sectional study

“…PICP was defined as concurrent utilisation of two or more benzodiazepines, two or more psychotropics in the same class (e.g., two or more hypnotics), and two or more anticholinergic psychotropics for a total of 40 days during 2006. The estimation of concurrent drug utilisation has been described previously [23]. Briefly, information on prescribers' dosage instructions is available only as a free text section in the register and is therefore not statistically processable.…”

“…Substance-specific population average PDDs were estimated for each psychotropic substance, thus enabling the calculation of theoretical treatment periods based on date of purchase and purchased amount. A detailed description of PIP and associated prevalence rates have been reported previously [23]. …”

Prognostic value of the quality indicator “concurrent use of three or more psychotropic drugs” among residents of long-term-care facilities

“…To the Editor: We commend Lesén et al [1] for their excellent research investigating whether the quality indicator "concurrent use of three or more psychotropic drugs" captures use of potentially inappropriate psychotropic drugs (PIPs given to comorbid disease, and limited or unknown ability to predict poor health outcomes [3,4]. There is no evidence that potentially inappropriate drug use defined using Beers Criteria, the most widely cited explicit indicators, is associated with mortality or hospitalization among nursinghome residents [5].…”