Potentially inappropriate prescribing and cost outcomes for older people: a national population study

Abstract

• One third of the Irish population aged Ն70 years were prescribed at least one potentially inappropriate medication in 2007 based on European criteria.• There was a signficant association between polypharmacy and the risk of PIP. Polypharmacy was evaluated as the number of different repeat drug classes (Ն three prescription claims) per claimant.• The most prevalent PIP drugs were: proton pump inhibitors at maximum therapeutic dosage for >8 weeks (40 mg daily omeprazole, pantoprazole and esomeprazole, 30 mg daily lansoprazole and 20 mg daily rabeprazole); non-steroidal anti-inflammatories for >3 months; long-acting benzodiazepines for >1 month and drug duplication within the same therapeutic class.• The total expenditure on potentially inappropriate drugs was €45 631 319 in 2007 which is 9% of the overall expenditure on pharmaceuticals in those aged Ն70 years in Ireland. AIMSOptimization of drug prescribing in older populations is a priority due to the significant clinical and economic costs of drug-related illness. This study aimed to: (i) estimate the prevalence of potentially inappropriate prescribing (PIP) in a national Irish older population using European specific explicit prescribing criteria; (ii) investigate the association between PIP, number of drug classes, gender and age and; (iii) establish the total cost of PIP. METHODSThis was a retrospective national population study (n = 338 801) using the Health Service Executive Primary Care Reimbursement Service (HSE-PCRS) pharmacy claims database. The HSE-PCRS uses the WHO Anatomical Therapeutic Chemical (ATC) classification system and details of every drug dispensed and claimants' demographic data are available. Thirty PIP indicators (STOPP) were applied to prescription claims for those Ն70 years in Ireland in 2007. STOPP is a physiological system based screening tool of older persons' potentially inappropriate prescriptions assessing drug-drug and drug-disease interactions, dose and duration. RESULTSIn our study population PIP prevalence was 36% (121 454 claimants).The main contributors to this were: 56 560 (17%) prescribed proton pump inhibitors at maximum therapeutic dose for >8 weeks, 29 691 (9%) prescribed non-steroidal anti-inflammatories for >3 months, 17 676 (5%) prescribed long-acting benzodiazepines for >1 month and 16 201 (5%) prescribed duplicate drugs. The main determinant of PIP was polypharmacy. The likelihood of PIP increased with a significant linear and quadratic trend (P < 0.0001) with the number of drug classes.The maximum net ingredient cost of PIP was estimated to be €38 664 640. Total PIP expenditure was estimated to be €45 631 319, 9% of the overall expenditure on pharmaceuticals in those Ն70 years in 2007.

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Intravenous fluid use in the acutely unwell adult medical inpatient: improving practice through a clinical audit process

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Receipt of High Risk Medications among Elderly Enrollees in Medicare Advantage Plans

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