Physician and patient-related factors associated with inappropriate prescribing to older patients within primary care: a cross-sectional study in Brazil

Abstract

BACKGROUND: Physician and patient-related characteristics can influence prescription of medications to older patients within primary healthcare. Use of Brazilian criteria may indicate the real prevalence of prescription of potentially inappropriate medications to this population. OBJECTIVES: To evaluate prescription of potentially inappropriate medications to older patients within primary care and identify patient-related and prescribing physician-related factors. DESIGN AND SETTING: This cross-sectional study was conducted in 22 public primary care facilities in Brazil, among older people (≥ 60 years) who were waiting for medical consultations. METHODS: Interviews were conducted before and after the medical consultations. If the patient received a medical prescription at the consultation, all the drugs prescribed and the physician's medical council registration number were recorded. Prevalence ratios were estimated to ascertain the magnitude of prescription of potentially inappropriate medications, along with patient and physician-related factors associated with such prescription. RESULTS: In total, 417 older patients were included; 45.3% had received ≥ 1 potentially inappropriate medication, and 86.8% out of 53 physicians involved had prescribed ≥ 1 potentially inappropriate medication. The strongest patient-related factor associated with higher prevalence of prescription of potentially inappropriate medications was polypharmacy. Among physician-related factors, the number of patients attended, number of prescriptions and length of medical practice < 10 years were positively associated with prescription of potentially inappropriate medications. CONCLUSIONS: High prevalence of prescription of potentially inappropriate medications was observed. Physician-related characteristics can influence prescription of medications to older people within primary healthcare. This suggests that there is a need for interventions among all physicians, especially younger physicians.

Effectiveness of Interventions to Reduce Potentially Inappropriate Medication in Older Patients: A Systematic Review

“…A recent systematic review focused on non-clinical programs to reduce the inappropriate or unnecessary use of medicines observed that interventions consisting of education messages and recommended behavior alternatives were more likely to be successful in reducing the inappropriate use of medicines or medical procedures ( Lin et al, 2020 ). Educational strategies are essential to improve prescription, as observed by Amorim et al (2021) since physician-related characteristics can influence the number of PIM prescriptions.…”

The patterns and implications of potentially suboptimal medicine regimens among older adults: a narrative review

“…While the debate continues around the distinction between appropriate and inappropriate polypharmacy, this well-established link between polypharmacy and PIMs suggests even considered polypharmacy may contain specific drug–drug or drug–disease interactions that are suboptimal. Of interest, only a handful of studies that focused on measuring associations with PIMs provided a detailed definition of polypharmacy; 28 , 45 , 52 , 64 , 66 however, it remains unclear whether associations vary between doctor-prescribed and self-prescribed medicines. The relationship between education and PIMs use appears to have been less extensively researched, relative to the polypharmacy literature ( Table 12 ).…”

(In)Appropriate Prescription in the Elderly in Primary Health Care

“…10 Para além da polifarmácia e idade avançada, o sexo feminino associa-se frequentemente a PIM, assim como, em menor escala, a história pessoal de depressão ou o baixo nível socioeconómico. 5 As comorbilidades também contribuem para o aumento da vulnerabilidade do idoso à iatrogenia, uma vez que, se por um lado aumentam a probabilidade do doente estar polimedicado, aumentando o risco de interações fármaco -fármaco, por outro também influenciam a farmacocinética, aumentando o risco de interações doença -fármaco. 10…”

“…Estão frequentemente associados a reações adversas como quedas, hemorragias gastrointestinais ou delírio, assim como aumento dos internamentos hospitalares e maior morbimortalidade. 5,6 Podem ser definidas cinco categorias para os medicamentos associados a PMI: os que induzem alterações psicológicas; os que afetam a função renal; os que são inapropriados devido às interações medicamentosas que provocam; os que não podem ser usados em determinadas condições de morbilidade e os que necessitam de ajustes de dosagem. 3 Nos Estados Unidos, existirão todos os anos cerca de 180 000 eventos adversos relacionados com medicação, fatais ou quase fatais, em maiores de 65 anos, sendo que, pelo menos metade destes, serão evitáveis.…”