Inappropriate Dispensing Research Articles

Evaluating Prescriptions for the Elderly: Drug/Age Criteria as a Tool to Help Community Pharmacists

ObjectivesTo use drug/age criteria to determine (1) the prevalence of dispensing of drugs potentially inappropriate for use in elderly patients; (2) the dispensing rate of individual drugs considered potentially inappropriate for use in elderly patients; (3) the association between selected patient characteristics and the prevalence of potentially inappropriate drug dispensing. Design, Setting, ParticipantsA secondary database of 6,380 new prescription orders dispensed to patients of all ages in ambulatory pharmacies in a mid-western state was used retrospectively for the analysis. A total of 1,530 (23.9%) ofthe new prescription orders were dispensed to 1,185 elderly patients. InterventionsNot applicable. Main Outcome MeasuresName, strength, and daily dose of each drug dispensed were compared with drug/age criteria to determine whether a dispensed drug was inappropriate for use in elderly patients. The association of the rate of dispensing of potentially inappropriate drugs with characteristics of the elderly patients, including age, sex, race, number of comorbidities, and prescription drug insurance coverage type, was determined. ResultsA total of 170 patients (14.3%) were dispensed potentially inappropriate medications. The three most common medications were propoxyphene and propoxyphene combinations, prescription and nonprescription antihistamines, and digoxin at doses > 0.125 mg/day. There was no statistically significant association between inappropriate drug dispensing and patient age, sex, race, number of comorbidities, and prescription drug insurance coverage type. ConclusionPharmacists can use drug/age criteria as a tool for an initial check to assess the appropriateness of drugs used by the elderly. Elderly patients appear equally at risk of using potentially inappropriate medications regardless of demographic, disease, or insurance characteristics.

Drug Usage Evaluation (DUE) Activity in PSAOs

Summary To describe PSAO drug usage evaluation (DUE) activity during DUE's developmental stages, the authors surveyed 44 state PSAOs and one independent DUE program. Of those surveyed, 23 were operating DUE programs, 16 of which had been operational for less than 3years. All identified their most important goal to be that of reducing costs. This was closely followed by the goal of reducing and preventing inappropriate prescribing and dispensing. AU programs reported intervening when potential problems are identified. The DUE programs provide extensive information on drug use and provider behavior which is expected to have a profound impact on future pharmacy practice. It is likely that mnst PSAOs will eitheradd such a program or revise the current one.