Trends in potentially inappropriate prescribing amongst older UK primary care patients

Abstract

Prescription of potentially inappropriate medication, particularly benzodiazepines, to older people remains at a high level in the UK. Levels were higher than those seen in published data from the Netherlands, however the low rate of co-proxamol prescribing in the Netherlands explains much, but not all, of the difference. Future international comparisons, based on more careful delineation of the criteria, may play a valuable role in pharmaco-vigilance and can identify areas where regulation of prescribing may reduce risks to older patients.

Potentially inappropriate prescribing in an Irish elderly population in primary care

“…A high proportion of the potential IP identified in a Portuguese primary care study, using the Beers' ID tool only, was attributable to ticlopidine (14.9%) [13], a medicine not licensed for use in Ireland. A large number of general practices (n = 131) were involved in the study conducted in the UK, which reported a potential IP rate of 24.8% [14]. However, the rate of potential IP is less in other European centres (9.8% in Turkey and 12.5% in Finland) [9,11] compared with centres in the USA (21.3%, 23.5%, 28.8%).…”

“…Inappropriate prescription of long-acting benzodiazepines in older patients has been highlighted repeatedly in the literature over the last 25 years, in particular given the link with falls and fracture risk and the difficulties with successful withdrawal [35][36][37]. Despite this, long-acting benzodiazepines continue to be initiated and repeatedly prescribed for older patients in primary and secondary care in Ireland and other countries [10,[12][13][14]. These realities suggest that long-acting benzodiazepines should not be initiated in older patients, given their high propensity for psychological and physical dependency.…”

“…Beers' criteria were originally formulated in 1991 [7], updated in 1997 [8] and recently revised in 2003 [4]. Using Beers' criteria in primary care, IP rates of 9.8-38.5% have been reported in various European countries [9][10][11][12][13][14], while IP rates of 21.3-28.8% have been reported in the USA [15][16][17]. Beers' criteria have a number of serious deficiencies in relation to European prescribing patterns.…”

Potentially inappropriate medications among elderly Brazilian outpatients

“…32 In other studies that used the 2003 version of the Beers criteria, the PIMs that were most prescribed were long-action benzodiazepines, propoxyphene, amitriptyline and antihistamines. 10,12,14,27,33 Estrogen, muscle relaxants, ticlopidine, chlordiazepoxide and anti-inflammatory agents have also been cited. 12,27,33 In Brazil, Carvalho observed that anti-inflammatory agents, methyldopa, digoxin and benzodiazepines with long half-life were the PIMs most used by elderly people in the city of São Paulo.…”

“…10,12,14,27,33 Estrogen, muscle relaxants, ticlopidine, chlordiazepoxide and anti-inflammatory agents have also been cited. 12,27,33 In Brazil, Carvalho observed that anti-inflammatory agents, methyldopa, digoxin and benzodiazepines with long half-life were the PIMs most used by elderly people in the city of São Paulo. 16 Gorzoni observed that benzodiazepines, methyldopa, ergot derivatives and cyclandelate were the drugs most often found in analyses on medical files.…”