Abstract
BackgroundIn the elderly in Scandinavia, multi-dose drug dispensing (MDD) is a common alternative to ordinary prescriptions (OP). MDD patients receive their drugs in unit bags, one for each dose occasion. The prescribing procedure differs between MDD and OP. The aim of the present study was to investigate the association between MDD and quality of drug treatment (QDT).Methodology/Principal FindingsA cross-sectional study was performed of all inhabitants in Region Västra Götaland alive on December 31st 2007, aged ≥65 years, with ≥1 prescribed drug and ≥2 health care visits for ≥2 diagnoses for obstructive pulmonary disease, diabetes mellitus, and/or cardiovascular disease in 2005–2007 (n = 24,146). For each patient, drug treatment on December 31st 2007 was estimated from drugs registered in the Swedish Prescribed Drug Register. QDT was evaluated according to established quality indicators (≥10 drugs, Long-acting benzodiazepines, Drugs with anticholinergic action, ≥3 psychotropics, and Drugs combinations that should be avoided). Logistic regression, with adjustments for age, sex, burden of disease, and residence, was performed to investigate the association between MDD and QDT. Mean age was 77 years, 51% were females, and 20% used MDD. For all quality indicators, the proportion of patients with poor QDT was greater in patients with MDD than in patients with OP (all P<0.0001). Unadjusted and adjusted odds ratios (95% confidence intervals) for poor QDT (MDD patients vs. OP patients) ranged from 1.47 (1.30–1.65) to 7.08 (6.30–7.96) and from 1.36 (1.18–1.57) to 5.48 (4.76–6.30), respectively.Conclusions/SignificancePatients with MDD have poorer QDT than patients with OP. This cannot be explained by differences in age, sex, burden of disease, or residence. These findings must be taken into account when designing alternative prescribing systems. Further research is needed to evaluate causative factors and if the findings also apply to other dose dispensing systems.
Highlights
Dose dispensing systems are widespread over the world, but limited knowledge is available on safety aspects of such systems [1]
Gotaland alive at December 31st 2007 who met all of the inclusion criteria: (i) $65 years, (ii) $1 dispensed drug registered in the Swedish Prescribed Drug Register at any time from the start of the register (July 1st 2005) to December 31st 2007, and (iii) $2 health care visits for $2 diagnoses within the International Statistical Classification of Diseases and Related Health Problems (ICD10) codes for obstructive pulmonary disease (J44–J46), diabetes mellitus (E10–E14), or cardiovascular disease (I10–I13, I20–I25, I50) registered in the regional health care consumption database (VEGA) in 2005–2007
The proportion of patients with poor quality in drug treatment according to the quality indicators varied between 5.9% and 55% for patients with multi-dose drug dispensing (MDD), and between 2.6% and 19% for patients with ordinary prescriptions (OP) (Table 3)
Summary
Dose dispensing systems are widespread over the world, but limited knowledge is available on safety aspects of such systems [1]. Quality of prescribing can be measured by drug-specific quality indicators. In Sweden, the National Board of Health and Welfare has developed quality indicators to measure quality of drug treatment in older people [3]. These have been used both in research [4,5] and for benchmarking [6]. In the elderly in Scandinavia, multi-dose drug dispensing (MDD) is a common alternative to ordinary prescriptions (OP). MDD patients receive their drugs in unit bags, one for each dose occasion. The aim of the present study was to investigate the association between MDD and quality of drug treatment (QDT)
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