Prescribing In Elderly Patients Research Articles

370: National Patterns in Emergency Department Antibiotic Prescribing for Elderly Patients With Urinary Tract Infections, 1996-2005

370: National Patterns in Emergency Department Antibiotic Prescribing for Elderly Patients With Urinary Tract Infections, 1996-2005

Electronic Health Record Use and the Quality of Ambulatory Care in the United States

Electronic health records (EHRs) have been proposed as a sustainable solution for improving the quality of medical care. We assessed the association between EHR use, as implemented, and the quality of ambulatory care in a nationally representative survey. We performed a retrospective, cross-sectional analysis of visits in the 2003 and 2004 National Ambulatory Medical Care Survey. We examined EHR use throughout the United States and the association of EHR use with 17 ambulatory quality indicators. Performance on quality indicators was defined as the percentage of applicable visits in which patients received recommended care. Electronic health records were used in 18% (95% confidence interval [CI], 15%-22%) of the estimated 1.8 billion ambulatory visits (95% CI, 1.7-2.0 billion) in the United States in 2003 and 2004. For 14 of the 17 quality indicators, there was no significant difference in performance between visits with vs without EHR use. Categories of these indicators included medical management of common diseases, recommended antibiotic prescribing, preventive counseling, screening tests, and avoiding potentially inappropriate medication prescribing in elderly patients. For 2 quality indicators, visits to medical practices using EHRs had significantly better performance: avoiding benzodiazepine use for patients with depression (91% vs 84%; P = .01) and avoiding routine urinalysis during general medical examinations (94% vs 91%; P = .003). For 1 quality indicator, visits to practices using EHRs had significantly worse quality: statin prescribing to patients with hypercholesterolemia (33% vs 47%; P = .01). As implemented, EHRs were not associated with better quality ambulatory care.

Potentially Inappropriate Prescribing for Elderly Patients in 2 Outpatient Settings

Research has shown a high prevalence of potentially inappropriate medication prescribing (PIP) for elderly patients in outpatient settings, but little is known about whether a physician's practice setting influences prescribing attitudes. This study examines the prevalence of PIP among elderly patients in 2 out-patient practices, 1 located in a senior citizens center and 1 in a general family medicine clinic. The authors conducted a retrospective chart review of a random sample of 50 individuals aged 65 years or older from each practice. The 2003 version of the Beers criteria was used to identify PIP. Results show that some one fourth of the elderly sampled in both practices had 1 or more incidents of PIP. The most common potentially inappropriate drug classes prescribed were psychotropic agents and anti-inflammatory drugs. Demographic patient variables were not significantly associated with PIP. This study suggests that PIP may be prevalent across physician groups.

Utilisation des dérivés nitrés chez les patients âgés de 65 ans et plus hospitalisés en médecine interne

Background. – Nitrates are frequently prescribed drugs, although their indications are limited. We studied nitrates' prescription in elderly patients hospitalised in the internal medicine ward of a French teaching hospital. Methods. – Hospitalised patients aged 65 years and more and receiving nitrates in their usual treatment were identified prospectively. A standardised questionnaire was used during a structured medical interview conducted by the same physician for all patients. Informations regarding nitrates' prescription were studied according to the actual recommendations for their use: angina in patients with contraindication to betablockers, acute myocardial infarction and acute pulmonary oedema. Results. – Among 256 hospitalised elderly patients, 49 (19% [IC95%: 15–25]) were under nitrates therapy, because of either angina pectoris, heart failure or unknown reason. Cardiologists prescribed nitrates in accordance with guidelines significantly more frequently than non-cardiologists. Transdermal treatment was used in 69% of patients. Discussion. – In hospitalised patients aged 65 years and more who are prescribed nitrates in their usual treatment, at least one quarter have no recommended indication for its use. As almost one fifth of patients are receiving nitrates in their usual treatment, the medicoeconomic impact of these useless prescriptions could be significant. Nitrates prescribing can be optimized by following guidelines for their use, and restraining from prescribing the transdermal treatment which is more costly and without evidence-based clinical benefit compared to the oral route.

Inappropriate medication prescribing in community-dwelling elderly people living in Iran

To determine the prevalence of inappropriate medication prescribing in Middle Eastern community-dwelling elderly persons, and to determine factors associated with inappropriate prescribing. Prescriptions from 3,000 elderly-patient visits (> or =65 years) to physicians in Isfahan, Iran were collected between September and December 2002; only the first patient visit was considered in the study. Inappropriate prescriptions were defined according to Beers' explicit criteria (1997). The presence of at least one drug-drug interaction (DDI) and at least one drug-class duplication within each patient visit was also determined. Multivariate analyses were performed to determine factors associated with receiving at least one inappropriate medication. These factors included age, gender, number of prescribed medications per visit, DDIs, duplications, and physician's number of years of experience. Similar analyses were performed to determine whether these factors were associated with a composite index (defined as having at least one of the following: receiving at least one inappropriate prescription, DDI, or duplication). The mean age of our cohort was 72.6 (+/-5.7) years, and 1,735 (57.8%) were females. A total of 829 (27.6%) patients received at least one inappropriate prescription, 285 (9.5%) had at least one DDI during the visit, and 746 (24.9%) had at least one duplication during the visit. The three most inappropriately prescribed medication classes were antihistamines (29%), non-steroidal anti-inflammatory agents (23%) and benzodiazepines (16%). In multivariate analyses, the number of prescribed medications per visit was the only factor significantly associated with receiving at least one inappropriate prescription (OR 1.24; 95%CI: 1.16-1.32); analyses using the composite index as outcome gave similar results (OR: 1.70; 95%CI: 1.60-1.80). Our findings indicate a high prevalence of inappropriate prescribing in elderly patients. Given the potential severity of this problem, further steps need to be implemented to prevent this occurrence.

Key factors associated with the under-prescription of statins in elderly coronary heart disease patients: Results from the ELIAGE and ELICOEUR surveys

Introduction The reasons why statins are under-utilized in elderly patients remain poorly understood. The aim of this study was to identify the reasons given by cardiologist for the non-prescription of statins in elderly CHD patients. Methods Two cross-sectional pharmaco-epidemiological surveys were carried out among French cardiologists. The sample consisted of 1148 coronary patients aged 35 to 69 years and 1489 patients aged ≥ 70 years. Patients' risk factors, medical history, treatments, lipid values and the physicians' various motives for the non-prescription of statins were recorded. Results Patients not treated with statins reached 37% in the age-group ≥ 70 years and 14% in the age-group 35–69 years. The main reason given for statin non-prescription was the lack of a medical indication (2.5% of the age-group 35–69 years and 14% of the age-group ≥ 70 years). Among patients ≥ 70 years, the lack of indication was more often cited in the following conditions: 1) in very old patients (36% of lack of indication in the age-group > 85 years vs. 10% in 70–75 years), 2) when lipid values were not available (20% when data were not available vs. 9%) and 3) when the patient had no prior history of myocardial infarction (MI) (20% when no history of MI vs. 7%). These factors were not associated with lack of indication among patients < 70 years. History of intolerance or side effect was given for 1.3% and 14% of patients for each of the groups (35–69 and ≥ 70) and poor overall patient adherence was cited in 1% and 2%, respectively. Conclusion The primary reason for the under-prescription of statins in elderly coronary patients is the perceived lack of indication, which stresses the need of extensive guidelines for prescription in elderly patients. Several factors associated with this perception seem to be specific to the elderly.

Development of prescribing indicators for elderly medical inpatients.

To identify and improve suboptimal prescribing for elderly patients we have developed a number of prescribing indicators which focus on areas of concern and allow evaluation of the benefit of interventions. We report here on fourteen indicators. The indicators are of three types: a) purely descriptive with no attempt to define optimal values, e.g. number of items prescribed per patient; b) based on unnecessary or potentially harmful prescribing, e.g. duplication; c) assessing the appropriateness of prescribing specific drugs or combinations e.g. digoxin and warfarin/aspirin in atrial fibrillation (AF). Appropriateness was defined on the basis of objective research findings and involved comparing individual patient clinical records to criteria for appropriate prescribing. Prescribing and personal data were collected for medical inpatients aged 65 years or over in 19 hospitals in England and Wales. A total of 1686 patients were included, median age 81 years, 41% were male. Patients were prescribed 11475 items, mean 4.6 regular items per patient. Completion of drug allergy/sensitivity statements varied from 3 to 93% between units. Use of generic name and specification of a maximum frequency of administration for "as required' medicines were more consistent, ranging from 76-94% and 52-81% respectively. Little duplication of therapy was seen. Benzodiazepines were prescribed for 22% patients, but were appropriate in only approximately one third of these. Of the 2% patients prescribed an angiotensin converting enzyme inhibitor with a potassium-sparing diuretic or potassium supplement, prescription of the combination was appropriate in 84%. Coprescription of steroids with beta 2-adrenoceptor agonists appeared excessive in 67% patients receiving a beta 2-adrenoceptor agonist, as only 51% had documented evidence of steroid responsiveness or another indication for steroids. Stroke prophylaxis in AF was inadequate: 22% patients prescribed digoxin also received warfarin or aspirin 300 mg whereas 64% should have received the coprescription. These prescribing indicators are sensitive to inappropriate prescribing for elderly medical inpatients and cover a wide range of therapeutic areas. They should enable changes in prescribing quality to be measured objectively. Interhospital variation in casemix resulted in substantial differences in the proportion of patients in whom it would have been appropriate to prescribe specific drugs or combinations and prevented derivation of reference ranges of optimal prescribing for four indicators.

PRESCRIPTIONS FOR ELDERLY PATIENTS

Medical Journal of AustraliaVolume 1, Issue 24 p. 1269-1269 Correspondence PRESCRIPTIONS FOR ELDERLY PATIENTS First published: 01 June 1969 https://doi.org/10.5694/j.1326-5377.1969.tb62332.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume1, Issue24June 1969Pages 1269-1269 RelatedInformation