Abstract
BackgroundInappropriate medication prescription is a common cause of preventable adverse drug events among elderly persons in the primary care setting.ObjectiveThe aim of this systematic review is to quantify the extent of inappropriate prescription to elderly persons in the primary care setting.MethodsWe systematically searched Ovid-Medline and Ovid-EMBASE from 1950 and 1980 respectively to March 2012. Two independent reviewers screened and selected primary studies published in English that measured (in)appropriate medication prescription among elderly persons (>65 years) in the primary care setting. We extracted data sources, instruments for assessing medication prescription appropriateness, and the rate of inappropriate medication prescriptions. We grouped the reported individual medications according to the Anatomical Therapeutic and Chemical (ATC) classification and compared the median rate of inappropriate medication prescription and its range within each therapeutic class.ResultsWe included 19 studies, 14 of which used the Beers criteria as the instrument for assessing appropriateness of prescriptions. The median rate of inappropriate medication prescriptions (IMP) was 20.5% [IQR 18.1 to 25.6%.]. Medications with largest median rate of inappropriate medication prescriptions were propoxyphene 4.52(0.10–23.30)%, doxazosin 3.96 (0.32 15.70)%, diphenhydramine 3.30(0.02–4.40)% and amitriptiline 3.20 (0.05–20.5)% in a decreasing order of IMP rate. Available studies described unequal sets of medications and different measurement tools to estimate the overall prevalence of inappropriate prescription.ConclusionsApproximately one in five prescriptions to elderly persons in primary care is inappropropriate despite the attention that has been directed to quality of prescription. Diphenhydramine and amitriptiline are the most common inappropriately prescribed medications with high risk adverse events while propoxyphene and doxazoxin are the most commonly prescribed medications with low risk adverse events. These medications are good candidates for being targeted for improvement e.g. by computerized clinical decision support.
Highlights
The elderly population is increasing, resulting in a concomitant increase in chronic diseases and functional impairment [1]
Approximately one in five prescriptions to elderly persons in primary care is inappropropriate despite the attention that has been directed to quality of prescription
Several factors increase the risk of Inappropriate medication prescription (IMP) to elderly persons, including physiological changes like reduction in renal and hepatic function, both of which are detrimental of drug metabolism and disabilities like visual and cognitive decline
Summary
The elderly population is increasing, resulting in a concomitant increase in chronic diseases and functional impairment [1]. One cause of preventable adverse drug events is the prescription of inappropriate medications. Inappropriate medication prescription (IMP) has been defined as the prescription(s) that introduce(s) a significant risk of an adverse drug related event when there is evidence for an or more effective alternative medication [6]. It can be described as the failure to achieve the optimal quality of medication use [7]. Inappropriate medication prescription is a common cause of preventable adverse drug events among elderly persons in the primary care setting
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