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.
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
1. One hundred and ninety-five patients undergoing low-dose prednisone or prednisolone therapy were investigated. Blood pressure, weight, serum urea, sodium and potassium were recorded before therapy and again after at least 1 year of therapy. 2. The rise in both mean systolic and mean diastolic blood pressure was paralleled by an increase in the prevalence of arbitrarily defined hypertension. 3. There was no relationship between change of blood pressure and either dose of corticosteroid or duration of therapy. Blood pressure before therapy was the main determinant of the change in blood pressure. 4. Mean serum sodium levels rose slightly but serum potassium levels did not change during the follow-up period. There was no significant weight gain. 5. These results indicate that treatment of asthma and rheumatoid arthritis with prednisolone or prednisolone in low dose does not cause hypertension or biochemical features suggestive of mineralocorticoid excess.
SummaryFour-hundred and twenty-eight school leavers of 3 ethnic groups (white, black and Asian) were screened for blood pressure, resting pulse rate and general anthropometric characteristics. Asian pupils were both shorter and lighter than the other two groups whilst black males were heavier and taller. There was no significant difference in the mean systolic or diastolic blood pressure between the 3 groups, although the black pupils had a stronger family history of hypertension, particularly on the mother's side. These observations differ in some respects from other ethnic blood pressure studies and establish values for the local population.
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