Abstract
PurposePotentially inappropriate prescriptions (PIPs) criteria are widely used for evaluating the quality of prescribing in elderly. However, there is limited evidence on their association with adverse drug reactions (ADRs) across healthcare settings. The study aimed to determine the prevalence of PIPs, defined by the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) criteria, in the Swedish elderly general population and to investigate the association between PIPs and occurrence of ADRs.MethodPersons ≥65 years old were identified from a random sample of 5025 adults drawn from the Swedish Total Population Register. A retrospective cohort study was conducted among 813 elderly with healthcare encounters in primary and specialised healthcare settings during a 3-month period in 2008. PIPs were identified from the Swedish Prescribed Drug Register, medical records and health administrative data. ADRs were independently identified by expert reviewers in a stepwise manner using the Howard criteria. Multivariable logistic regression examined the association between PIPs and ADRs.ResultsOverall, 374 (46.0 %) persons had ≥1 PIPs and 159 (19.5 %) experienced ≥1 ADRs during the study period. In total, 29.8 % of all ADRs was considered caused by PIPs. Persons prescribed with PIPs had more than twofold increased odds of experiencing ADRs (OR 2.47; 95 % CI 1.65–3.69). PIPs were considered the cause of 60 % of ADRs affecting the vascular system, 50 % of ADRs affecting the nervous system and 62.5 % of ADRs resulting in falls.ConclusionPIPs are common among the Swedish elderly and are associated with increased odds of experiencing ADRs. Thus, interventions to decrease PIPs may contribute to preventing ADRs, in particular ADRs associated with nervous and vascular disorders and falls.Electronic supplementary materialThe online version of this article (doi:10.1007/s00228-015-1950-8) contains supplementary material, which is available to authorized users.
Highlights
The rapid growth in the proportion of older population increases demands on healthcare systems worldwide [1]
Interventions to decrease PIPs may contribute to preventing adverse drug reactions (ADRs), in particular ADRs associated with nervous and vascular disorders and falls
Several factors contribute to the challenge of the care of the elderly, including comorbidities and chronic conditions often requiring multiple medications [2, 3], age-related physiological changes leading to increased sensitivity to drug effects [4] and limited evidence of drug effectiveness and safety in older and frail patients [5]
Summary
The rapid growth in the proportion of older population increases demands on healthcare systems worldwide [1]. Previous studies have reported that up to 61 % of older patients in hospital settings develop adverse drug reactions (ADRs) [6], and approximately half of them. Evidence of an association between PIPs identified by STOPP criteria and the occurrence of ADRs is limited [19] and mainly studied in hospital settings [20,21,22]. As the majority of healthcare contacts of the elderly occur in primary care [23], we aimed to determine the prevalence of PIPs, defined by STOPP criteria, in the Swedish elderly general population, including all care settings, and to study the association between PIPs and occurrence of ADRs
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