What Factors Predict Potentially Inappropriate Primary Care Prescribing in Older People?

Abstract

PIP amongst older people in the UK, although declining, remains at a high level. The association of PIP with age, deprivation and care homes is largely explained by the higher overall prescribing rates in these groups. The overall rise in prescribing emphasizes that polypharmacy does not necessarily increase PIP and attempts to reduce PIP by focusing on polypharmacy have not been successful. Reductions in PIP have previously been achieved by introducing national guidelines (e.g. co-proxamol), but might also be achieved by alerting practitioners at the point of prescribing.

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

“…Previous research has shown that a large number of drugs is a strong predictor for use of potentially inappropriate drugs [4]. We found that 72% of individuals with the indicator used PIP [3].…”

An Educational Intervention to Prevent Irrational Prescribing By Primary Care Physicians: Results from Turkey from the OTC-SOCIOMED Project Second Phase

“…Some studies have indicated that GPs do not consider themselves sufficiently competent to terminate medications initiated by specialists (Carey et al, 2008;Conner & Norman, 1995). Only one-third of physicians informed their patients about this subject at each interview.…”

Medications as Risk Factor for Falls

“…Polypharmacy is a common phenomenon in older adults, and whilst targeting polypharmacy represents an obvious approach to reducing PIP, the distinction between appropriate and inappropriate polypharmacy is not clearly defined [22]. One study demonstrated that despite rises in polypharmacy in the UK, largely suspected to be associated with better chronic disease management, no subsequent increase in PIP was seen, indicating that prescribing more medications does not always translate to a rise in PIP [15]. In this era of increased focus on chronic disease management and multi-morbidities, this is an on-going challenge for those responsible for prescribing in primary care.…”

“…The availability of clinical data allowed more complete assessment of PIP. The use of a large national database gave a clear insight into the more common issues in PIP nationally rather than the local focus of some previous studies [15].…”

“…PIP in older people has been associated with significant morbidity, adverse drug events (ADEs), hospitalisation and mortality [10][11][12][13]. PIP prevalence rates in older people have ranged from 14% to 37% in the US and Canada respectively, 19.8% in Europe [14] and 28% in the United Kingdom (UK) using the Beers criteria [15]. Further studies of PIP in the UK using large representative national databases, to identify the most common national PIP issues have been called for [15].…”