Trends in Prevalence and Determinants of Potentially Inappropriate Prescribing in the United States: 2007 to 2012

Abstract

Objectives To estimate prevalence and determinants of potentially inappropriate prescribing (PIP) among US older adults using 2012 Beers criteria. Design Retrospective cohort study in a random national sample of Medicare beneficiaries. Setting 2007–2012 fee-for-service Medicare beneficiaries. Participants US population aged >65 years with Part A, B and D enrollment in at least 1 month during a calendar year (N=38,250 patients; 1,308,116 observations) Measurement We used 2012 Beers criteria to estimate the prevalence of ≥1 PIP within each calendar month and over a 12-month period using data on diagnoses or conditions present in the previous 12 months. To account for the dependence of multiple monthly observations of a single person when estimating 95% confidence intervals (CI) we used generalized estimating equations. We used logistic regression to identify independent determinants of PIP. Results The point-prevalence of PIP decreased from 37.6% (95%CI: 37.0–38.1) in 2007 to 34.2% (95%CI: 33.6–34.7) in 2012, with a statistically significant 2% (95%CI: 1–3%) decline per year assuming a linear trend. One year period-prevalence declined from 64.9% in 2007 to 56.6% in 2012. The strongest predictor of PIP was the number of drugs dispensed. Individuals aged 70 years or older and those seen by a geriatrician were less likely to receive PIP. Conclusion From 2007 to 2012, the prevalence of PIP in US older adults decreased according to 2012 Beers criteria but remains high, still affecting a third each month and more than a half over 12 months. The number of dispensed prescription could be used to target future interventions.

Patient‐ and health care‐related factors associated with initiation of potentially inappropriate medication in community‐dwelling older persons

“…A recent study from Canada also reported that increasing age had a slightly greater protective effect among women than men . The finding of the higher risk of PIMs among women is in concordance with previous studies . A potential explanation for this result may be more frequent healthcare service use among women …”

“…The results of this study also showed that there were regional differences in PIM initiation between hospital districts. Previous studies provide mixed findings related to regional differences with PIM use . For example, studies have reported lower rates of PIMs in smaller hospitals or rural areas and regions in smaller populations .…”

Physician Factors Associated with Polypharmacy and Potentially Inappropriate Medication Use

“…A recent large cohort study of US Medicare beneficiaries found that the strongest predictor of PIM use among the factors studied was the number of drugs dispensed. 23 Similarly, multiple studies have consistently revealed that taking more prescription medications increases the risk of exposure to a PIM. 24,25 The number of prescription medications, as well as the number of PIMs themselves, could be a reasonable red flag that warrants deprescribing for older multimorbid patients in FMPs.…”

Measures of Drug Prescribing at Care Transitions in an Internal Medicine Unit

“…Psycholeptics also represent an important and common type of potentially inappropriate medication class prescribed, especially diazepam. Turning to potentially inappropriate medication use prevalence, the data presented in our study are consistent with the findings of previous studies . This study reveals a high potentially inappropriate medication use prevalence both on admission (ranging from 69.9% to 72.6%) and discharge times (ranging from 67.6% to 73.5%), with a good agreement between the 2 lists of criteria.…”