Does ongoing general practitioner care in elderly patients help reduce the risk of unplanned hospitalization related to Beers potentially inappropriate medications?

Abstract

To compare estimates of unplanned hospitalizations associated with exposure to Beers potentially inappropriate medications (PIM) in elderly people receiving different levels of ongoing general practitioner (GP) care. Using the pharmaceutical claims and other linked health data of 245,436 Western Australians aged ≥65 years with one or more claims for a medication from a PIM-related drug class (1993-2005), we applied an enhanced case-time-control design to obtain odds ratios (OR) for unplanned hospitalization, from which attributable fractions, numbers, proportions and rates of admissions related to PIM exposure were derived. Overall, 383,150 unplanned hospitalizations ("index subjects") were identified. PIM exposure was associated with a similar relative risk of unplanned hospitalization in elderly people receiving the lowest and highest levels of ongoing GP care, but with a decreasing risk in the three highest tiers; adjusted OR (95% CI; attributable fractions) were 1.15 (1.09-1.21; 12.9%), 1.36 (1.27-1.46; 26.6%), 1.20 (1.15-1.26; 16.9%) and 1.13 (1.09-1.17; 11.4%) for groups from the lowest to highest levels. However, those with higher GP coverage had higher rates of PIM-related hospitalization. Similar patterns were shown for commonly used high-risk PIM (temazepam, diazepam, oxazepam, naproxen and digoxin). Increased requirement for ongoing GP contact in less healthy elderly people appears to help minimize their risk of unplanned hospitalization due to PIM-related harm. GPs should continue to avoid Beers medications in older patients where possible, given their greater predisposition to medication exposure (including PIM) and adverse drug events. Nevertheless, close monitoring of elderly patients who need to use PIM should prove beneficial.