Abstract
PurposeThe purpose of this study is to establish the prevalence of potentially inappropriate prescribing (PIP) in middle-aged adults (45–64 years) in two populations with differing socio-economic profiles, and to investigate factors associated with PIP, using the PROMPT (PRescribing Optimally in Middle-aged People’s Treatments) criteria.MethodsA retrospective cross-sectional study was conducted using 2012 data from the Enhanced Prescribing Database (EPD), covering the full population in Northern Ireland and the Health Services Executive Primary Care Reimbursement Service (HSE-PCRS) database, covering the most socio-economically deprived third of the population in this age group in the Republic of Ireland. The prevalence for each PROMPT criterion and overall prevalence of PIP were calculated. Logistic regression was used to investigate the association between PIP and gender, age group and polypharmacy.ResultsThis study included 441,925 patients from the EPD and 309,748 patients from the HSE-PCRS database. Polypharmacy was common in both datasets (46.7 % in the HSE-PCRS and 20.3 % in the EPD). The prevalence of PIP was 42.9 % (95%CI 42.7, 43.1) in the HSE-PCRS and 21.1 % (95%CI 21.0, 21.2) in the EPD. Age group, female gender and polypharmacy were significantly associated with PIP in both populations (p < 0.05) and polypharmacy had the strongest association.ConclusionsPIP is common amongst middle-aged people with the risk of PIP increasing with polypharmacy. Differences in the prevalence of polypharmacy and PIP between the two populations may relate to heterogeneity in healthcare services and different socio-economic profiles, with higher rates of multimorbidity and associated polypharmacy in more deprived groups.Electronic supplementary materialThe online version of this article (doi:10.1007/s00228-015-2003-z) contains supplementary material, which is available to authorized users.
Highlights
As prescribing guidelines generally focus on single diseases [1], the increasing prevalence of patients with two or more chronic conditions, or multimorbidity [2], creates challenges in determining the appropriateness of prescribing
potentially inappropriate prescribing (PIP) is common amongst middle-aged people with the risk of PIP increasing with polypharmacy
Differences in the prevalence of polypharmacy and PIP between the two populations may relate to heterogeneity in healthcare services and different socio-economic profiles, with higher rates of multimorbidity and associated polypharmacy in more deprived groups
Summary
As prescribing guidelines generally focus on single diseases [1], the increasing prevalence of patients with two or more chronic conditions, or multimorbidity [2], creates challenges in determining the appropriateness of prescribing. The focus of potentially inappropriate prescribing (PIP) has been on older people (routinely defined as aged 65 years and over) due to the complexity of prescribing for patients in this age group, including changes in pharmacokinetics and pharmacodynamics [3], and a high prevalence of multimorbidity (82 % aged ≥85 years; 65 % aged 65–84 years) [2]. PROMPT (PRescribing Optimally in Middle-aged People’s Treatments) represents a set of 22 explicit prescribing criteria, organised according to physiological system, which have been developed for middle-aged adults [8]. This set of criteria may be applied to administrative datasets, or drug lists alone (i.e. in the absence of clinical information), to determine the prevalence of PIP in middle-aged people [8]. The criteria are similar to the Screening Tool for Older Persons’ Prescription (STOPP) [10] in mainly specifying circumstances in which a medicine may be inappropriate (co-morbidities, dosage, duration of use) rather than stating drugs to avoid in all cases as is more common in the Beers criteria [9]
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