Inappropriate prescribing in a large community-dwelling older population: a focus on prevalence and how it relates to patient and physician characteristics

Amos, Tony B.; Keith, S.W.; Canale, S. Del; Orsi, Paolo; Maggio, Marcello; Baccarini, S; Gonzi, Gianluca; Liu, M.; Maio, Vittorio

doi:10.1111/jcpt.12212

Cited by 20 publications

(22 citation statements)

References 39 publications

(41 reference statements)

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“…The rate of PIMs (60.7%, n = 164) is higher than the rates previously reported in the US, Canada, and Italy, and even higher than previous studies in Saudi Arabia that reported high rates of PIM use. 7,12,14,18 Previous studies conducted in Saudi Arabia showed PIMs rates of 52.5% 7 and 2.1%-2.5%. 19 Differences in the tested populations of these studies may have contributed to the discrepancy between the reported results from previous studies and those obtained herein, since the present study was conducted in a family medicine setting; in Al Odhayani et al, 7 798 older patients were arbitrarily selected from Prince Sultan Medical Military City through the patient register from the family medicine chronic disease clinics in the Home Health Care programme; in Al-Omar et al, 19 the authors conducted a retrospective cross-sectional study of outpatient pharmacy prescription records of older patients at Riyadh Military Hospital.…”

Section: Comparison With Existing Literaturementioning

confidence: 96%

“…13 An Italian study showed a lower percentage of PIM use (28.0%), and that females were more likely to be exposed to PIMs than males. 14 In Taiwan, the prevalence of having at least one PIM was reported to be high at 82.67%, and these were mostly prescribed by internist or family physicians and neurologists or psychiatrists. 15 The present study was conducted to determine the prevalence of PIM use among older patients (aged ≥65 years) in a family medicine setting in Saudi Arabia based on the Beers 2015 criteria, and to identify the factors associated with PIMs.…”

Section: Introductionmentioning

confidence: 99%

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Potentially inappropriate medications in older patients based on Beers criteria: a cross-sectional study of a family medicine practice in Saudi Arabia

et al. 2020

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BackgroundThe use of potentially inappropriate medications (PIMs) is an important issue in older patients who are at risk of adverse drug events.AimTo determine the prevalence of PIM use, according to Beers criteria, among an older population (aged ≥65 years) in a large family medicine setting, and to identify the associated risks.Design & settingA prospective cross-sectional study of patients aged ≥65 years was conducted from June 2017 to June 2018 at the Family and Community Medicine (FCM) clinics of King Saud Medical City (KSMC) in Riyadh, Saudi Arabia.MethodThis cross-sectional study included patients aged ≥65 years who were seen at new appointments or followed-up at the FCM clinics of KSMC in Riyadh, Saudi Arabia. Data were collected by extensive face-to-face interviews and from the patients’ medical records.ResultsA total of 270 older patients aged 72.41 ±6.23 years (mean ±standard deviation [SD]) were included in the present study. The prevalence of PIMs was 60.7% (n = 164). Multivariate analyses identified three independent variables associated with PIMs: incremental age per 5 years (odds ratio [OR] 1.47, 95% confidence intervals [CI] = 1.15 to 1.88; P = 0.002), female sex (OR 1.95, 95% CI = 1.10 to 3.42; P = 0.021), and polypharmacy (OR 8.21, 95% CI = 4.58 to 14.7; P<0.001). The most common PIMs used were 39.4% related to proton pump inhibitors (PPI), 25.2% to diuretics (other than spironolactone), 10.6% to non-steroidal anti-inflammatory drugs (NSAIDs), and 8.7% to aspirin use.ConclusionThis study showed high prevalence of PIMs. Increasing age, female sex, and polypharmacy were found to be significant risk factors for PIM use. The frequency of morbidities was not significantly different among patients with PIMs compared to those without PIMs, except for hypertension and osteoarthritis, which were more common in the PIMs group. The present study reinforces the importance of comprehensive medication management and reviews.

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Section: Comparison With Existing Literaturementioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Potentially inappropriate medications in older patients based on Beers criteria: a cross-sectional study of a family medicine practice in Saudi Arabia

et al. 2020

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“… Review + Delphi/consensus 0 5 CW AGS Choosing Wisely Workgroup [ 34 ] 2014 US To identify another five services that physicians and patients should question. Delphi/consensus 0 5 CW Amos [ 35 ] 2015 US To determine the prevalence of PIMs for older adults in Elimia-Romagna, Italy, using updated Maio criteria. Empirical analysis 0 16 Other Bulger [ 36 ] 2013 US To identify five services that physicians and patients should question.…”

Section: Resultsmentioning

confidence: 99%

Are low-value care measures up to the task? A systematic review of the literature

Vries

Struijs

Heijink

et al. 2016

BMC Health Serv Res

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BackgroundReducing low-value care is a core component of healthcare reforms in many Western countries. A comprehensive and sound set of low-value care measures is needed in order to monitor low-value care use in general and in provider-payer contracts. Our objective was to review the scientific literature on low-value care measurement, aiming to assess the scope and quality of current measures.MethodsA systematic review was performed for the period 2010–2015. We assessed the scope of low-value care recommendations and measures by categorizing them according to the Classification of Health Care Functions. Additionally, we assessed the quality of the measures by 1) analysing their development process and the level of evidence underlying the measures, and 2) analysing the evidence regarding the validity of a selected subset of the measures.ResultsOur search yielded 292 potentially relevant articles. After screening, we selected 23 articles eligible for review. We obtained 115 low-value care measures, of which 87 were concentrated in the cure sector, 25 in prevention and 3 in long-term care. No measures were found in rehabilitative care and health promotion. We found 62 measures from articles that translated low-value care recommendations into measures, while 53 measures were previously developed by institutions as the National Quality Forum. Three measures were assigned the highest level of evidence, as they were underpinned by both guidelines and literature evidence. Our search yielded no information on coding/criterion validity and construct validity for the included measures. Despite this, most measures were already used in practice.ConclusionThis systematic review provides insight into the current state of low-value care measures. It shows that more attention is needed for the evidential underpinning and quality of these measures. Clear information about the level of evidence and validity helps to identify measures that truly represent low-value care and are sufficiently qualified to fulfil their aims through quality monitoring and in innovative payer-provider contracts. This will contribute to creating and maintaining the support of providers, payers, policy makers and citizens, who are all aiming to improve value in health care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1656-3) contains supplementary material, which is available to authorized users.

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“…The primary outcome variable was a CDI diagnosis after exposure to the index facility, defined as rehospitalization with CDI within 30 days of discharge from the hospital or, for the second cohort of individuals discharged from the hospital to a SNF, a CDI diagnosis on an MDS assessment after the admission assessment (Figure ). Because 30‐day rehospitalization is often used as a measure of facility quality, and CDI prevalence may be associated with overall facility quality, a second outcome of 30‐day non‐CDI rehospitalization was included as a negative control. An association between CDI prevalence and non‐CDI rehospitalization would suggest that we were measuring factors associated with 30‐day re‐hospitalization other than the facilities’ CDI prevalence.…”

Section: Methodsmentioning

confidence: 99%

Effect of Clostridium difficile Prevalence in Hospitals and Nursing Homes on Risk of Infection

Joyce

Mylonakis

Mor

2017

J American Geriatrics Society

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Inappropriate prescribing in a large community-dwelling older population: a focus on prevalence and how it relates to patient and physician characteristics

Abstract: The high prevalence of PIM exposure among older adults is a substantial issue in the region. Knowing how patient and GP characteristics relate to PIMs exposure may improve the design and targeting of initiatives for improving prescribing safety in this population.

Cited by 20 publications

References 39 publications

Potentially inappropriate medications in older patients based on Beers criteria: a cross-sectional study of a family medicine practice in Saudi Arabia

Potentially inappropriate medications in older patients based on Beers criteria: a cross-sectional study of a family medicine practice in Saudi Arabia

Are low-value care measures up to the task? A systematic review of the literature

Effect of Clostridium difficile Prevalence in Hospitals and Nursing Homes on Risk of Infection

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