Prevalence of potentially inappropriate prescribing in older people in primary care and its association with hospital admission: longitudinal study

Abstract

ObjectiveTo determine whether hospital admission is associated with potentially inappropriate prescribing among older primary care patients (aged ≥65 years) and whether such prescribing was more likely after hospital admission than before.DesignLongitudinal study of retrospectively extracted data from general practice records.Setting44 general practices in Ireland in 2012-15.ParticipantsAdults aged 65 years or over attending participating practices.ExposureAdmission to hospital (any hospital admission versus none, and post-admission versus pre-admission).Main outcome measuresPrevalence of potentially inappropriate prescribing assessed using 45 criteria from the Screening Tool for Older Persons’ Prescription (STOPP) version 2, analysed both as rate of distinct potentially inappropriate prescribing criteria met (stratified Cox regression) and binary presence of potentially inappropriate prescribing (logistic regression) and adjusted for patients’ characteristics. A sensitivity analysis used matching with propensity scores based on patients’ characteristics and diagnoses.ResultsOverall 38 229 patients were included, and during 2012 the mean age was 76.8 (SD 8.2) years and 43% (13 212) were male. Each year, 10.4-15.0% (3015/29 077 in 2015 to 4537/30 231 in 2014) of patients had at least one hospital admission. The overall prevalence of potentially inappropriate prescribing ranged from 45.3% (13 940/30 789) of patients in 2012 to 51.0% (14 823/29 077) in 2015. Independently of age, sex, number of prescription items, comorbidity, and health cover, hospital admission was associated with a higher rate of distinct potentially inappropriate prescribing criteria met; the adjusted hazard ratio for hospital admission was 1.24 (95% confidence interval 1.20 to 1.28). Among participants who were admitted to hospital, the likelihood of potentially inappropriate prescribing after admission was higher than before admission, independent of patients’ characteristics; the adjusted odds ratio for after hospital admission was 1.72 (1.63 to 1.84). Analysis of propensity score matched pairs showed a slight reduction in the hazard ratio for hospital admission to 1.22 (1.18 to 1.25).ConclusionHospital admission was independently associated with potentially inappropriate prescribing. It is important to determine how hospital admission may affect appropriateness of prescribing for older people and how potential adverse consequences of admission can be minimised.

The MedSafer Study: A Controlled Trial of an Electronic Decision Support Tool for Deprescribing in Acute Care

“…5,15,20,22 Our study found much higher rates of deprescribing than those quoted in the literature. 22,37 Although one recent large longitudinal study using the STOPP criteria identified hospitalization as a risk factor for PIM acquisition at discharge (odds ratio = 1.72), 38 this is in contrast to our intervention and demonstrates the importance of establishing a culture of deprescribing in acute care. 20,22,31,36 Hospitalization can serve as an opportunity for deprescribing because many admissions (eg, for falls or delirium) relate to adverse effects of medications.…”

Tackling potentially inappropriate prescribing

“…This echoes findings from a large cross sectional study in the UK, albeit using different indicators of prescribing safety and reporting a somewhat lower prevalence of potentially inappropriate prescribing 7. Potentially inappropriate prescribing is associated with subsequent adverse drug events and hospital admissions, as well as reduced quality of life,6 but what the new study also shows is that the risk of potentially inappropriate prescribing is increased after hospital admission 6…”

“…Nevertheless, the size and scale of the problem is considerable, and the observational study by Pérez and colleagues (doi:10.1136/bmj.k4524) shows that close to half of older patients in the Republic of Ireland are exposed to potentially inappropriate prescribing each year 6. This echoes findings from a large cross sectional study in the UK, albeit using different indicators of prescribing safety and reporting a somewhat lower prevalence of potentially inappropriate prescribing 7.…”

Mye feilmedisinering etter sykehusinnleggelse

“…I en studie som nylig er publisert i tidsskriftet BMJ, undersøkte forfatterne sammenhengen mellom sykehusinnleggelser og risiko for feilmedisinering og overmedisinering (1). Studien var basert på journalopplysninger fra irske allmennlegekontorer for flere enn 38 000 pasienter over 64 år for perioden 2012-15.…”