Patient, Physician, and Health‐System Factors Influencing the Quality of Antidepressant and Sedative Prescribing for Older, Community‐Dwelling Adults

Abstract

Various patient and health-system factors influence the quality of antidepressant and sedative prescribing for older community-dwelling adults. Longer consultations and the use of computer systems with prescribing support may minimize potentially inappropriate antidepressant prescribing. As medication numbers increase, exposure to PI sedatives is more likely, requiring medication review and monitoring.

Factors associated with potentially inappropriate medication use in community-dwelling older adults in the United States: a systematic review†

“…Age was most frequently examined categorically with the categories ranging in size from 5 to 20 years. Race and ethnicity were statistically significant in just five of the 13 studies that examined this . The specific racial and ethnic categories compared varied widely across studies.…”

“…The overall risk of bias was low in 18 studies and moderate in four studies (Table ) . The deficiencies in the studies that had more than a low risk of bias were potential biases due to confounding, missing information about participants at baseline, and low or unreported response rates in surveys.…”

“…Twenty‐two studies evaluated determinants of PIM use in community‐dwelling and ambulatory clinic patients . Most studies were either cross‐sectional analyses of claims data or analyses of large nationally representative surveys such as the Medical Expenditure Panel Survey (MEPS) or the National Ambulatory Medical Care Survey (NAMCS) (Tables and ).…”

“…Nineteen studies evaluated patient factors contributing to PIM use in community‐dwelling adults or those attending ambulatory clinics (Table ). Seventeen used multivariable regression, adjusting for a combination of patient factors, patient and system factors or patient system and clinician factors . Two studies used bivariate analysis …”

“…Being a woman was positively associated with PIM use in 10 studies Among the six studies which did not report a statistically significant association between sex and PIM use were two that used bivariate instead of multivariate analysis, a small ( n = 82) study limited to Chinese American older adults in a single city, and two that had a sample that was more than 80% women . However, one study using nationally representative MEPS data did not report a statistically significant association with sex and PIM use when their final multivariate model was adjusted for number of medications …”