Prevalence Of Inappropriate Prescribing Research Articles

Prevalence of Inappropriate Antibiotic Prescribing with or without a Plausible Antibiotic Indication among Safety-Net and Non-Safety Net Populations.

Clinicians can prescribe antibiotics inappropriately without coding the indication for antibiotics. Whether the prevalence of inappropriate antibiotic prescribing with or without a plausible indication differs between safety-net and non-safety-net populations is unknown. To assess differences in inappropriate antibiotic prescribing with or without a plausible indication between safety-net and non-safety net populations. Cross-sectional. Office visits in the 2016, 2018, 2019 National Ambulatory Medical Care Survey with ≥ 1 antibiotic prescription among children (0-17years) and adults (18-64years). Inappropriate antibiotic prescribing with a plausible indication (visits with infection-related diagnosis codes that do not warrant antibiotics, e.g., acute bronchitis); inappropriate prescribing without a plausible indication (visits with codes that are not antibiotic indications, e.g., hypertension). By age group, we used linear regression to assess differences between safety-net (public/no insurance) and non-safety net populations (privately insured), controlling for patient and visit characteristics. Analyses included 67,065,108 and 122,731,809 weighted visits for children and adults, respectively. Among visits for children in the safety-net and non-safety populations, the prevalence of inappropriate antibiotic prescribing with a plausible indication was 11.7% and 22.0% (adjusted difference: -8.0%, 95% CI: -17.1%, 1.0%); the prevalence of inappropriate prescribing without a plausible indication was 11.8% and 8.6% (adjusted difference: -2.0%, 95% CI: -4.6%, 0.6%). Among visits for adults in the safety-net and non-safety populations, the prevalence of inappropriate antibiotic prescribing with a plausible indication was 12.1% and 14.3% (adjusted difference: -0.1%, 95% CI -9.4%, 9.1%); the prevalence of inappropriate prescribing without a plausible indication was 48.2% and 32.3% (adjusted difference: 12.5%, 95% CI: 3.6%, 21.4%). Inappropriate antibiotic prescribing with or without a plausible antibiotic indication is common in all populations, highlighting the importance of broad-based antibiotic stewardship initiatives. However, targeted initiatives focused on improving coding quality in adult safety-net settings may be warranted.

Inappropriate prescribing in patients with renal impairment

AbstractObjectivesThe aim of this study was to assess the prevalence of inappropriate prescribing (IP) in an acute care hospital and to identify medication classes that are inappropriately prescribed. IP occurs in patients with poor renal function in hospital and in outpatient settings. The extent of IP among patients with impaired renal function varies between countries and medical specialties.MethodsThe retrospective descriptive study included patients aged 18 years and older who were admitted to hospital for more than 24 h with documented estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 and were receiving at least one systemic medication. Patient data, medications and eGFR results were compiled from the electronic health records. IP was assessed taking into consideration the eGFR, absolute glomerular filtration rate (absGFR) and estimated creatinine clearance (eCrCl).Key findingsThe study included 399 patients (63% female; 37% male) with an average age of 79 years (range 42–99). At least one inappropriate prescription was prescribed to 236 (59.1%) patients and 90 patients (38.1%) received ≥3 inappropriately prescribed medications. The prevalence of IP was 32.0% (n = 790), 29.2% (n = 568) and 30.6% (n = 596) when eGFR, absGFR and eCrCl values were used, respectively. Anticoagulants (n = 261, 43.6%) were the most inappropriately prescribed class of medication followed by analgesics (n = 85, 33.9%) and antidiabetic agents (n = 55, 39.6%).ConclusionsResults of the study show that dosage adjustment of medication in renal impairment to avoid IP needs to be addressed. Choice of renal function estimate did not significantly affect the overall prevalence of IP among the study population.

Prevalence of inappropriate prescribing in complex chronic patients: Time trends in a health department of Valencia, Spain (2015–2019)

Background and objectiveInappropriate prescribing (IP) is an important cause of health problems among elderly and complex chronic patients (CCPs). ObjectiveSurveillance of IP prevalence among elderly and CCPs in a health department. IP time trends across the period 2015–2019. MethodDescriptive population-based study. Setting: ‘València-Clínic-Malvarrosa’ Health Department, Valencia, Spain. Period: 2015–2019. Subjects: Complete set of CCPs in the department, defined by clinical risk groups. Number of CCPs (annual average in the period): 9102 (75% ≥65 years of age). IP was measured using an indicator consisting of 13 specific types of prescriptions defined as inappropriate. Analyses: frequencies and time trends, both overall and by specific type. ResultsOverall prevalence of IP ranged from 0.276 (2015) to 0.289 (2018) per patient, without time trend. The most frequent inappropriate prescription was type 1: “≥75 years of age with inappropriate medication”, which showed a stable rate across the period. Some types of inappropriate prescriptions displayed favourable decreasing time trends, while others showed no change or an unfavourable trend (i.e., joint prescription of absorbents and urinary antispasmodics). ConclusionsIP prevalence is a serious and persistent problem among the elderly and CCPs, especially in the oldest. It is therefore necessary its continuous surveillance (overall and by specific types of prescription). As well as interventions to optimise prescribing, thus improving the quality and efficiency of care for the elderly and CCPs.

Implications of inappropriate prescription of oral nutritional supplements on the quality of life of cancer outpatients: a cross-sectional comparative study

Background and aimsOral nutritional supplements (ONS) are considered a cornerstone in the treatment plan of malnutrition in cancer patients. However, the prevalence of inappropriate prescription of ONS is high. In this study, we aim to investigate the effect of inappropriate oral nutritional supplementation (consisting of prescription of ONS without evident clinical indication, or the absence of ONS when at risk of malnutrition) on the quality of life of cancer outpatients.MethodsA cross-sectional comparative study was conducted in 104 cancer outpatients, receiving ONS without prior malnutrition risk screening (n = 51), and patients not receiving ONS (n = 53). Nutritional risk screening was performed using the abridged patient-generated subjective global assessment (ab-PG-SGA). The quality of life was assessed using EORTC QLQ-C30 version 3.0 questionnaire. Multivariate analysis was conducted to determine the predictors of quality-of-life scales. Age (years), malnutrition (ab-PG-SGA scores), BMI (kg/m2), TSF (mm), MUAC (cm), ONS (yes, no) were entered into the linear regression analysis as predictors (backward stepwise linear regression analysis).ResultsThe prevalence of malnutrition risk (ab-PG-SGA ≥ 6) was 74%. The median score of the ab-PG-SGA for ONS receiving group was significantly higher (p = 0.045). Furthermore, univariate analysis showed that the scores of the global health status (QoL) and the role functioning (RF) scales were significantly lower for the ONS receiving group (p = 0.020 and p = 0.016, respectively). Multivariately, malnutrition, inappropriate ONS prescription, and triceps skin fold were found to be predictors of the RF scale, while malnutrition was the only predictor for the QoL.ConclusionThe inappropriate ONS prescription does not improve nutritional status or quality of life of cancer outpatients.

Appropriateness Of Prescribing Of Direct Oral Anticoagulants: A Prospective Cohort Study At CHU UCL Mont-Godinne-Dinant

Background and Objective Direct oral anticoagulants (DOACs) have been developed to address some of the limitations of Vitamin-K antagonists (VKAs) and are claimed to be easier to use. However, deviations from the recommended use have been reported, sometimes leading to serious adverse events (Sorensen R et al. BMJ Open 2013, Hussain S et al. Eur J Hosp Pharm 2013, Lim SL et al. Med J Aust 2013, Legrand M et al. Arch Intern Med 2011, Bene J et al. Ann Pharmacother 2012). Our objective was to evaluate the appropriateness of prescribing DOACs in real-life clinical practice. Setting and Method We conducted a prospective cohort study including patients admitted to a 450-bed teaching hospital (Belgium) from April to July 2013, who were taking rivaroxaban (Xarelto®) or dabigatran etexilate (Pradaxa®). A clinical pharmacist interviewed each patient to collect clinical and pharmaceutical data. Additional relevant information was retrieved from the electronic medical record. Appropriateness of prescribing was evaluated using the 10 criteria of the Medication Appropriateness Index (Samsa GP et al. J Clin Epidemiol 1994, Hanlon JT et al. J Clin epidemiol 1992). Explicit instructions were added, based on EU summary of the product characteristics and (inter)national guidelines. Due to limited cost-effectiveness data in Belgium, the tenth criterion of the MAI was not used. Main outcome measures The primary outcome measure was the prevalence of inappropriate prescribing, namely the proportion of patients with ≥1 inappropriate criterion. Secondary outcome measures included (a) a description of the main categories of inappropriateness prescribing, (b) comparison of results for patients on Xarelto® as compared to those on Pradaxa®, (c) the prevalence of adverse drug events and their relationship to inappropriate prescribing and (d) a description of interventions made by the clinical pharmacist to optimize prescribing. Results Fifty-two patients were evaluated (median age 74 years, range 51-89; 29 and 23 taking Xarelto® and Pradaxa®, respectively). Twenty-eight (53.8%) patients had at least one inappropriate rating: 1 inappropriate criterion in 26.9% and >1 in 26.9% of patients ([Figure 1][1]). The most frequent inappropriate criteria were: wrong dosage (32.7%, e.g. dose not adapted to renal function); inappropriate choice and modalities of administration (28.8%, e.g. prescription of a NOAC in a VKA-naive patient with extreme body weight, once daily administration of Pradaxa®); and unpractical modalities of administration (25.0%, e.g. Pradaxa® in non-adherent patients) ([Table 1][2]). Results were overall similar when comparing Pradaxa® and Xarelto®, indicating that the trend of inappropriate prescribing might not be related to one specific DOAC. Twenty-four patients (47.0%) had experienced one adverse event (e.g. 8 patients had a stroke or a transient ischemic accident, 6 had hematomas or non-characteristic bleedings, 3 had epistaxis incidents and 2 patients reported dyspepsia); and 7.8% more than one adverse event. The clinical pharmacist made 29 interventions during the study period; e.g. 11 request for specific coagulation assay, 8 switches to another oral anticoagulant, 3 dose adjustments and 3 therapeutic education. Thirteen patients had one clinical pharmacist intervention and 8 patients benefited from 2 interventions. ![Figure 1][3] Figure 1 Percentage of inappropriate ratings (C) per patient, using the Medication Appropriateness Index View this table: Table 1 Detailed ratings of appropriateness using the Medication Appropriateness Index (N) Conclusion The quality of prescribing DOACs was suboptimal. Off-label use was frequent and suggests that reinforcing education of health care professionals is needed. This should be a priority for the future. Disclosures: No relevant conflicts of interest to declare. [1]: #F1 [2]: #T1 [3]: pending:yes

Therapeutic optimization through goal-oriented prescription in nursing homes

Background People living in nursing homes are highly vulnerable and frail. Polypharmacy and inappropriate prescription (IP) are also common problems. Objectives The objectives of the study are (i) to study the baseline situation and calculate the frailty index (FI) of the residents, (ii) to assess the results of routine clinical practice to do a pharmacotherapy review (patient-centred prescription (PCP) model) (Molist Brunet et al., Eur Geriatr Med. 2015;6:565–9) and (iii) to study the relationship between IP and frailty, functional dependence, advanced dementia and end-of-life situation. Setting Two nursing homes in the same geographical area in Catalonia (Spain). Method This was a prospective, descriptive and observational study of elderly nursing home residents. Each patient’s treatment was analysed by applying the PCP model, which centres therapeutic decisions on the patient’s global assessment and individual therapeutic goal. Main outcome measure Prevalence of polypharmacy and IP. Results 103 patients were included. They were characterized by high multimorbidity and frailty. Up to 59.2% were totally dependent. At least one IP was identified in 92.2% of residents. Prior to the pharmacological review, the mean number of chronic medications prescribed per resident was 6.63 (SD 2.93) and after this review it was 4.97 (SD 2.88). Polypharmacy decreased from 72.55% to 52.94% and excessive polypharmacy fell from 18.62% to 5.88%.The highest prevalence of IP was detected in people with a higher FI, in those identified as end-of-life, and also in more highly dependent residents (p < 0.05). Conclusions People who live in nursing homes have an advanced frailty. Establishing individualized therapeutic objectives with the application of the PCP model enabled to detect 92.2% of IP. People who are frailer, are functionally more dependent and those who are end-of-life are prescribed with inappropriate medication more frequently.

Evaluation of Rationality of Geriatric Patients' Prescription Based On Beers Criteria in a Tertiary Care Hospital in India.

AIM:Irrational prescribing for geriatric patients has become an important public health problem worldwide. Because India is one of the most populated countries having a great proportion of old people in the world, studies on the prevalence of inappropriate prescriptions can be very beneficial to increase the knowledge of health care providers and to reduce the occurrence of adverse drug events among this population.METHODS:A group of 482 inpatients above 64 years old were enrolled in a prospective study. Chart review method was used. The data were collected from patients’ prescription and medicine charts. Each prescription was checked individually for the inappropriate drug by using the AGS 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Suggestions were given to the physicians for inappropriate medications.RESULTS:The prevalence of potentially inappropriate medication is found to be 11.66% (n = 56). Out of 56 inappropriate medications, the most frequently inappropriate medication is Digoxin (25%) followed by Sprinolactone 19.64%. This study founds age, some medication, length of stay and number of diagnosis as predictors for getting a PIM. Feedback of the physicians varies based on the suggestions.CONCLUSION:This study concludes that the prevalence of PIMs among geriatrics patients of ≥ 65 years old is 11.66%. Some predictors have been identified for getting a PIM. This study shows that physicians’ feedback is dependent on the suggestions being given.

A review of urinary tract infection management for patients admitted to the emergency department: Assessment of adherence to guidelines and identification of hospitalization criteria

Background & objectives Community-acquired urinary tract infections (UTIs) are the second most common indication for antibiotic prescription in France. Previous studies on the adherence to guideline on antibiotic use reported a prevalence of inappropriate prescriptions varying from 20 to 50%, both in the community and hospital settings. The misuse of antibiotics not only have an important economic impact but can also lead to therapeutic impasses. This study aimed at establishing the current management of UTIs for patients admitted to the emergency department (ED) of our hospital. Methods This retrospective observational study was conducted in the European Hospital of Marseille January 2015 and May 2016. Consecutive patients admitted to the ED for a suspected UTI were included, including patients hospitalized ( n = 50) or discharged ( n = 50) after their ED admission. Assessment of adherence to guidelines for antibiotic prescription was conducted using the guidelines of the French-speaking society of infectious disease (SPILF). Results In the hospitalized group, 22 (44%) antibiotic prescriptions initiated at the ED did not comply with national guidelines. The two main causes for inappropriate prescriptions were the use of two antibiotics in patients with no severity criteria (15, 68%) and/or the use of a non-recommended drug (6, 27%). In this group, 17 (35%) antibiotic prescriptions ordered by the urologist on patients’ discharge did not comply with national guidelines. The two main causes of inappropriate prescriptions were the use of a non-recommended drug (9, 53%) and an inadequate duration of treatment (9, 53%). In the discharged group, 29 (60%) of the antibiotic prescriptions ordered at the ED did not comply with national guidelines. The two main causes of inappropriate prescriptions were an inadequate duration of treatment (23, 79%) and the use of a non-recommended drug (19, 66%). We could also identify discrepancies between reasons for hospitalization in our cohort compared to the criteria for hospitalization mentioned in the national guidelines. Discussion & conclusions This study has identified areas of improvement for the management of UTIs in our hospital. Our suggestions for optimization include educational materials and a decision tree displayed at the ED and specific therapeutic protocols in our computerized prescription system.

Identification of inappropiate prescribing in a Geriatric outpatient clinic using the Criteria Stopp Start

Abstract Identified the inappropriate prescription of drugs in elderly assisted geriatric outpatient clinic in the region of Vale do Rio Pardo in Rio Grande do Sul according to the criteria of STOPP and START. Cross-sectional study of 221 elderly, based on retrospective analysis of medical records using comprehensive geriatric assessment data held in the first visit. Descriptive variables were age, sex, number of pathologies and number of medications in use. And the study variables were potentially inappropriate medications (MPI) and potentially omitted medications (MPO), according to the STOPP and START criteria. Descriptive statistics were performed with frequencies, means and standard deviations where appropriate. It was observed 157 (71%) female patients. The average age was 75 (±8.26) years, 49.8% in the range of 75-84 years. The average number of drugs was 3 (±2.27), with 22.63% using 5 or more medications. The average pathologies was 3.45 (±2.02). They identified 194 prescriptions of MPI and observed 93 MPO. The most identified were the MPI for the cardiovascular system, especially β noncardioselective blockers and acetylsalicylic acid. Also MPO were found most of the cardiovascular system, with emphasis on acetylsalicylic acid and inhibitors of angiotensin converting enzyme. This is sample of elderly with significant prevalence of inappropriate prescribing of drugs. Studies using the STOPP criteria and START in different health care settings can qualify the care provided to the elderly.

Inappropriate prescribing of antithrombotic therapy in Ethiopian elderly population using updated 2015 STOPP/START criteria: a cross-sectional study

BackgroundInappropriate use of antiplatelets and anticoagulants among elderly patients increases the risk of adverse outcomes. The aim of this study was to assess the prevalence of inappropriate prescribing of antithrombotic therapy in hospitalized elderly patients.MethodsA retrospective cross-sectional, single-center study was conducted at the Gondar University Hospital. A total of 156 hospitalized elderly patients fulfilling the inclusion/exclusion criteria were included in the study. The Screening Tool for Older Person’s Prescription/Screening Tool to Alert doctors to Right Treatment criteria version 2 were applied to patients’ data to identify the total number of inappropriate prescribing (IPs) including potentially inappropriate medications and potential prescribing omissions.ResultsA total of 70 IPs were identified in 156 patients who met the inclusion criteria. Of these, 36 (51.4%) were identified as potentially inappropriate medications by the Screening Tool for Older Person’s Prescription criteria. The prevalence of IP per patient indicated that 58 of the 156 (37.2%) patients were exposed to at least one IP. Of these, 32 (55.2%) had at least one potentially inappropriate medication and 33 (56.9%) had at least one potential prescribing omission. Patients hospitalized due to venous thromboembolism (adjusted odds ratio [AOR] =29.87, 95% confidence interval [CI], 1.26–708.6), stroke (AOR =7.74, 95% CI, 1.27–47.29), or acute coronary syndrome (AOR =13.48, 95% CI, 1.4–129.1) were less likely to be exposed to an IP. An increase in Charlson comorbidity index score was associated with increased IP exposure (AOR =0.60, 95% CI, 0.39–0.945). IPs were about six times more likely to absent in patients prescribed with antiplatelet only therapy (AOR =6.23, 95% CI, 1.90–20.37) than those receiving any other groups of antithrombotics.ConclusionIPs are less common in elderly patients primarily admitted due to venous thromboembolism, stroke, and acute coronary syndrome, and those elderly patients prescribed with only antiplatelet. Patients with higher Charlson comorbidity index were, however, associated with increased IPs exposure. Our study may guide further research to reduce high-risk prescription of antithrombotics in the elderly.

PCV4 - Prevalence of Inappropriate Prescribing of Antithrombotic Therapy in Ethiopian Elderly Population using Updated 2015 Stopp/Start Criteria

The aim of this study was to assess the prevalence of inappropriate prescribing of antithrombotic therapy in hospitalized elderly patients. A retrospective cross-sectional, single-center study was conducted at the Gondar University Hospital (GUH). Hospitalized elderly patients aged ≥65 years with Congestive Heart Failure, Venous Thromboembolism, Stroke, Atrial Fibrillation, Acute Coronary Syndrome, Peripheral Valvular Disease, elderly patients with a known co-morbidity of cardiovascular diseases, patients with a history of coronary, cerebral or PVDs, and patients prescribed with any of antithrombotics were included in the study. The STOPP/START criteria version-2 was applied to each patients’ data to identify the total instances of Inappropriate Prescription (IP) including potentially inappropriate medications (PIMs), potential prescribing omissions (PPOs). A total of 70 IPs were identified in 156 patients identified who fulfilled the inclusion criteria. Of which, 36 (51.4%) PIMs were identified by the STOPP criteria. The prevalence of IP per patient indicated that of the 156 patients, 58 (37.2%) were exposed to at least one IP. Of which, 32 (55.2%) had at least one PIM and 33 (56.9%) had at least one PPO. Patients hospitalized due to VTE (AOR=29.87, 95% CI, 1.26-708.6), stroke (AOR=7.74, 95% CI, 1.27-47.29) or ACS (AOR=13.48, 95% CI, 1.4-129.1) were more likely to be exposed to an IP. An increase in CCI score was associated with reduced IP exposure (AOR= 0.60, 95% CI, 0.39-0.945). Patients prescribed with antiplatelet only therapy were about 6 times more likely (AOR= 6.23, 95% CI, 1.90 - 20.37) to have an IP than those with any other groups of antithrombotic. The findings indicate that inappropriate prescribing of antithrombotic therapy were common among hospitalized elderly patients. Our study may guide further research to reduce high-risk prescribing of antithrombotics in older people.

Evaluation of inappropriate prescribing to the hospitalized elderly patients in Al Shifa hospital, Gaza, Palestine

Background: The current study aimed to assess the prevalence of inappropriate prescribing (IP) for hospitalized elderly patients at Al Shifa Hospital, Gaza, Palestine. Methods: This study was a retrospective cross-sectional study. A total of 2385 prescribed drugs for 380 elderly inpatients in internal, cardiology, and respiratory departments were screened for IP. Four criteria were used to detect IP using chart review method; Drug-drug interactions (DDIs), drug contra-indications (CI), duplication of therapy and Beers' criteria 2012. Results: The results showed that 44.2% of patients had at least one IP. Around 33.2% of the patients had DDIs, 19.2% had IP according to Beers' criteria and 1.1% had drug CI. There was no duplication of therapy. A total of 323 IP instances were detected. Of them, 74% for DDIs and 24.8% for Beers' criteria. The prevalence of overall IP was significantly influenced by age (p-value=0.024), polypharmacy (p-value<0.001), degree of morbidity (p-value<0.001), and departments (p-value=0.018). The prevalence of DDIs was influenced by polypharmacy (p-value<0.001), degree of morbidity (p-value=0.001), and departments (p-value=0.005). Finally, the prevalence of IP according to Beers' criteria was significantly influenced by departments with the highest in the cardiology department (29.7%) (P-value=0.007). Conclusions: Although the overall IP was common, it was not far higher than that reported worldwide. The majority of IP was DDIs. Age, polypharmacy, degree of morbidity and departments influenced the occurrence of IP.

Predictive Validity of the Beers and Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) Criteria to Detect Adverse Drug Events, Hospitalizations, and Emergency Department Visits in the United States.

To compare the predictive validity of the 2003 Beers, 2012 American Geriatrics Society (AGS) Beers, and Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria. Retrospective cohort. Managed care administrative claims data from 2006 to 2009. Commercially insured persons aged 65 and older in the United States (N=174,275). Association between adverse drug events (ADEs), emergency department (ED) visits, and hospitalization outcomes and inappropriate medication use using time-varying Cox proportional hazard models. Measures of model discrimination (c-index) and hazard ratios (HRs) were calculated to compare unadjusted and adjusted models for associations. The prevalence of inappropriate prescribing was 34.1% for the 2012 AGS Beers criteria, 32.2% for the 2003 Beers criteria, and 27.6% for the STOPP criteria. Each set of criteria modestly discriminated ADEs in unadjusted analyses (STOPP criteria: hazard ratio (HR)=2.89, 95% confidence interval (CI)=2.68-3.12, C-index=0.607; 2012 AGS Beers criteria: HR=2.51, 95% CI=2.33-2.70, C-index=0.603; 2003 Beers criteria: HR=2.65, 95% CI=2.46-2.85, C-index=0.605). Similar results were observed for ED visits and hospitalizations. The c-indices increased to between 0.65 and 0.70 in adjusted analyses. The kappa for agreement between criteria was 0.80 for the 2003 and 2012 AGS Beers criteria, 0.58 for the 2012 AGS Beers and STOPP criteria, and 0.59 for the 2003 Beers and STOPP criteria. For the three outcomes, the 2012 AGS Beers criteria had the highest sensitivity (61.2-71.2%) and the lowest specificity (41.2-70.7%), and the STOPP criteria had the lowest sensitivity (53.8-64.7%) but the highest specificity (47.8-78.1%). All three criteria were modestly prognostic for ADEs, EDs, and hospitalizations, with the STOPP criteria slightly outperforming both Beers criteria. With low sensitivity, low specificity, and low agreement between the criteria, they can be used in a complementary fashion to enhance sensitivity in detecting ADEs.

Inappropriate prescribing to older patients admitted to hospital: A comparison of different tools of misprescribing and underprescribing

PurposeThis study aims to assess inappropriate prescribing (IP) to elderly patients during the month prior to hospitalization and to compare different IP criteria. MethodsAn observational, prospective and multicentric study was carried out in the internal medicine services of seven Spanish hospitals. Patients aged 75years and older were randomly selected after hospital admission for a year. To assess potentially inappropriate medicines (PIMs), the Beers and STOPP criteria were used and to assess potentially prescribing omissions (PPOs), the START criteria and ACOVE-3 medicine quality indicators were used. An analysis to assess factors associated with IP was performed. Results672 patients [median age (Q1–Q3) 82 (79–86) years, 55.9% female] were included. Median prescribed medicines in the month prior to hospitalization were 10(Q1–Q3 7–13). The prevalence of IP was 87.6%, and 54.3% of patients had PIMs and PPOs concurrently. A higher prevalence rate of PIMs was predicted using the STOPP criteria than with the Beers criteria (p<0.001) and a higher prevalence of PPOs using the ACOVE-3 criteria than using the START criteria (p<0.001) was observed. Polypharmacy (≥10 medicines) was the strongest predictor of IP [OR=11.34 95% confidence interval (CI) 4.96–25.94], PIMs [OR=14.16, 95% CI 6.44–31.12], Beers-listed PIMs [OR=8.19, 95% CI 3.01–22.28] and STOPP-listed PIMs [OR=8.21, 95% CI 3.47–19.44]. PIMs was the strongest predictor of PPOs [OR=2.79, 95% CI 1.81–4.28]. ConclusionsA high prevalence of polypharmacy and PIMs and PPOs were reported. More than half the patients had simultaneous PIMs and PPOs. The related factors to PIMs and PPOs were different.

Appropriateness of prescribing dabigatran etexilate and rivaroxaban in patients with nonvalvular atrial fibrillation: a prospective study.

Direct oral anticoagulants have been developed to address some of the drawbacks of vitamin-K antagonists. However, special attention should be given when using these drugs, especially in patients with renal insufficiency, questionable compliance, and those at high risk of bleeding. To evaluate the appropriateness of prescribing dabigatran etexilate (DE) and rivaroxaban in patients with nonvalvular atrial fibrillation (NVAF) in real-life clinical practice. This was a prospective study that included patients presenting to a teaching hospital from April to mid-October 2013, who were taking rivaroxaban or DE for NVAF. Appropriateness of prescribing was evaluated using 9 of the 10 criteria of the Medication Appropriateness Index. The primary outcome measure was the prevalence of inappropriate prescribing. Secondary outcome measures included (a) categories of inappropriateness, (b) prevalence of adverse drug events, and (c) interventions made by a clinical pharmacist to optimize prescribing. A total of 69 patients were evaluated; 16 patients (23%) had 1 inappropriate criterion, and an additional 18 (26%) had more than 1 inappropriate criterion. The most frequent inappropriate criteria were inappropriate choice (28% of patients), wrong dosage (26%), and impractical modalities of administration (26%). An adverse event (AE) was found in 51% of patients (including 8 patients with transient ischemic attack/stroke). The clinical pharmacists performed 48 interventions, and 94% were accepted by the physician. Inappropriate use of DE and rivaroxaban in patients with NVAF is frequent and possibly leads to AEs. Reinforcing education of health care professionals and patients is needed. Collaboration with clinical pharmacists can contribute to better use.

Inappropriate Prescribing Among Elderly Home Care Patients in Japan

Although several previous studies have examined the prevalence and risk factors associated with inappropriate prescribing (IP) among elderly patients, as identified by the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) criteria, no research has been conducted among elderly home care patients. This study aimed to explore the prevalence of IP and its risk factors as identified by the STOPP/START criteria among elderly home care patients in Japan. Cross-sectional study. Home care settings in Japan. Eighty-nine patients aged 65 years or older who received regular home visiting services from Yamato Clinic between May 2013 and June 2013. The prevalence of IP and its risk factors as identified by the STOPP/START criteria. Of the study population, 40.4% had at least one potentially inappropriate medication and 60.7% had at least one incidence of underprescribing. Risk factors for potentially inappropriate medications were hypertension, constipation, and polypharmacy, while those for underprescription were osteoporosis and polypharmacy. The prevalence of IP among elderly home care patients is high, with risk factors that include not only polypharmacy but also several specific underlying medical conditions.

Potentially inappropriate medication use among institutionalized elderly individuals in southeastern Brazil

In recent decades, the elderly population in Brazil has grown rapidly, as has concern for the health of this population. Institutionalization in nursing homes has appeared as an alternative form of health care for frail elderly that live alone. The present study evaluated the pharmacotherapy and inappropriate drug prescriptions for institutionalized elderly patients living in long-term institutions in southeastern Brazil. This research was conducted at five institutions with a total sample of 151 individuals aged at least 60 years. Databases were used to identify drug interactions, defined daily dose and inappropriate prescriptions. The prevalence of drug intake among the elderly was 95.36%, and there were an average of 3.31 ± 1.80 drug prescriptions per individual. Based on Beers criteria, the prevalence of inappropriate prescriptions was 25.83%. In addition, 70.2% of prescriptions were prescribed at a higher dosage than the defined daily dose (ATC/WHO). Potential drug interactions were identified for 54.11% of prescriptions; 81.42% of these were of moderate severity. The main inappropriate drugs were prescribed for cardiovascular and nervous system problems. Institutionalized elderly individuals presented a high consumption and misuse of medications, requiring professional intervention to monitor prescriptions and improve the quality of service for this population.

Overprescribing In China, Driven By Financial Incentives, Results In Very High Use Of Antibiotics, Injections, And Corticosteroids

In appropriate prescribing is a global problem. It is especially salient in China, where drug sales constitute a major portion of health care providers' incomes, price distortions are rampant, and oversight is lax. However, few data exist on the prevalence of inappropriate prescribing in China. This study, the first of its kind in China, examined 230,800 prescriptions written between 2007 and 2009 by 784 community health institutions in 28 cities across China. The data show substantial overprescribing, including twice as many prescriptions for antibiotics as recommended by the World Health Organization and rates of injection that are three times higher than in similar countries. These findings point to the need to integrate rational prescribing into China's ongoing health care reform.

Prescribing of potentially inappropriate medications for the elderly: an analysis based on the PRISCUS list.

The PRISCUS list of potentially inappropriate medications (PIM) for the elderly was published in 2010 and is the first systematically constructed list of this type in Germany. The aim of the present study is to estimate the baseline prevalence of the prescribing of PIM, as defined by the PRISCUS list. Pseudonymized claims data from three statutory health insurances in Germany, which together covered more than 8 million insurants, for the year 2007 were used to determine the age- and sex-standardized one-year period prevalence of PIM among the elderly, as well as the frequency of PIM prescribing per person. The study population included all insurants who were at least 65 years old and were continuously insured throughout the year 2007 or died during that year. Of the 804 400 elderly persons in the study population, 201 472 (25.0%) received at least one PIM prescription in 2007. The PIM prevalence was higher in women than in men (32.0% vs. 23.3%) and increased with age. The most commonly prescribed PIM were amitriptyline (2.6%), acetyldigoxin (2.4%), tetrazepam (2.0%), and oxazepam (2.0%). 8.8% of all elderly persons received the same PIM drug four or more times in 2007. These data show that PIM were frequently prescribed to elderly persons in Germany before the PRISCUS list was published. Medications on the PRISCUS list are not necessarily absolutely contraindicated, and this study contained no information about the individual risk/benefit analyses that may have been carried out before these drugs were prescribed; thus, no conclusion can be drawn about the prevalence of inappropriate prescribing. Further research is needed to validate the PRISCUS list, which was generated by expert consensus, as a basis for therapeutic guidelines in geriatric medicine.

Identificação e análise de prescrições de medicamentos potencialmente inapropriados para idosos em uma instituição hospitalar

The objective of this research was to identify and analyze the prevalence of potentially inappropriate drug prescriptions for elderly patients over 65 years of age, according to Beer's criteria, as well as to describe the adverse reactions arising from these prescriptions. This research is a descriptive cross-sectional study, developed in a hospital of Minas Gerais, Brazil. The sample consisted of 55 medical records, from which 342 prescriptions were analyzed. It was noted that 47.3% (26) of medical records and 51.2% (175) of the prescriptions contained potentially inappropriate medications. Regarding side effects, the prevalence was 42.3% (11) observed in 26 medical records. The Diazepam drug was largely responsible for reactions of 45.4% (5), being the most common type of reactions drowsiness and lethargy with 54.5% (6). It was concluded that the prevalence of inappropriate prescriptions is high, which may increase the risk of adverse reactions, thus complicating the clinical symptoms and prolonging hospitalization.