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.
The hazards of prescribing many drugs, including side-effects, drug interactions, and difficulties of compliance, have long been recognized as particular problems when prescribing for elderly people. The need for appropriate and rational prescribing for elderly patients has been prioritized in the National Service Framework for Older People. This review addresses the research evidence on epidemiolog y of prescribing in elderly patients, methods of measuring the quality, and the role of the prescriber and the multidisciplinary team in the day-to-day optimization of drug therapy.
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
prescribing indicators were effective in evaluating the performance of 102 hospitals on prescribing practice to medical in-patients aged >/=65 years. Prescribing to elderly medical in-patients is sub-optimal but targets were achieved by some hospitals. This should inspire those hospitals not achieving high standards to improve their performance. The higher level of inappropriate prescribing with increasing age is unacceptable.
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