Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals

Gallagher, Paul; Lang, Pierre Olivier; Cherubini, Antonio; Topinková, Eva; Cruz-Jentoft, Alfonso J.; Montero‐Errasquín, Beatriz; Mádlová, Pavla; Gasperini, Beatrice; Baeyens, Hilde; Baeyens, Jean Pierre; Michel, Jean Pierre; O’Mahony, Denis

doi:10.1007/s00228-011-1061-0

Cited by 289 publications

(342 citation statements)

References 37 publications

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“…Most of them were discharged and went home. In our study, polypharmacy was higher than that described in other studies focusing on patients' medicine consumption on hospital admission [11,13,28]. However, an exhaustive pharmacology anamnesis study was carried out in our study analysing the consumption of drugs the month before admission, not only at the time of admission, as well as a complete review of drug utilization from the primary care and hospital electronic medical records, and performing an exhaustive drug interview of patients and/or relatives.…”

Section: Discussionmentioning

confidence: 76%

“…A good level of inter-rater reliability has been described for the Beers, the STOPP/START criteria and the underprescribing ACOVE indicators [13,26,27]. All the interviewers were consultants or nurses trained in geriatric assessment and in the use of inappropriate prescribing criteria.…”

Section: Methodsmentioning

confidence: 99%

“…The prevalence of PIMs described in the studies range from 25% to 75% of patients and polypharmacy is the main factor associated with PIMs [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…The START (Screening Tool to Alert doctors to Right Treatment) criteria are a new tool in screening for PPOs in the elderly population, and the published results indicate a very high prevalence, between 51 and 72% of patients [13,15].…”

Section: Introductionmentioning

confidence: 99%

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Inappropriate prescribing to older patients admitted to hospital: A comparison of different tools of misprescribing and underprescribing

San-José

Agustí

Vidal

et al. 2014

European Journal of Internal Medicine

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Methods: An observational, prospective and multicentric study was carried out in the internal medicine services of seven Spanish hospitals. Patients aged 75 years and older were randomly selected after hospital admission for a year. To assess potentially inappropriate medicines (PIMs), the Beers and STOPP criteria were used and to assess Potentially Prescribing Omissions (PPOs), the START criteria and ACOVE-3 medicine quality indicators were used. An analysis to assess factors associated with IP was performed.Results: 672 patients [median age (Q1_Q3) 82 (79-86) years, 55.9% female] were included. Median prescribed medicines in the month prior to hospitalization were 10(Q1-Q3 7-13). The prevalence of IP was 87.6%, and 54.3% of patients had PIMs and PPOs concurrently. A higher prevalence rate of PIMs was predicted using the STOPP criteria than with the Beers criteria (p<.001) and a higher prevalence of PPOs using the ACOVE-3 criteria than using the START criteria (p<.001) was observed. Polypharmacy (≥10 medicines) was the strongest Conclusions: A high prevalence of polypharmacy and PIMs and PPOs were reported. More than half the patients had simultaneous PIMs and PPOs. The related factors to PIMs and PPOs were different.

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Section: Discussionmentioning

confidence: 76%

Section: Methodsmentioning

confidence: 99%

“…The prevalence of PIMs described in the studies range from 25% to 75% of patients and polypharmacy is the main factor associated with PIMs [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Inappropriate prescribing to older patients admitted to hospital: A comparison of different tools of misprescribing and underprescribing

San-José

Agustí

Vidal

et al. 2014

European Journal of Internal Medicine

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“…Previous studies have also shown a relationship between polypharmacy and PIMs using both 2003 Beers and 2008 STOPP in different settings, such as primary care programs, community pharmacies, nursing homes, and university hospitals (Ryan et al, 2009;Cahir et al, 2010;Maio et al, 2010;Gallagher et al, 2011;Chen et al, 2012). Studies conducted in health primary care centers, outpatient clinics and long term care settings have also reported a strong association between polypharmacy and risk of PIMs in Brazil (Oliveira et al, 2012;Faustino, Passarelli, Jacob-Filho, 2013;Santos et al, 2013;Vieira de Lima et al, 2013;Cassoni et al, 2014).…”

Section: Discussionmentioning

confidence: 94%

Exposure to potentially inappropriate medications in Brazilian elderly outpatients with metabolic diseases

Martins

Mori

Dórea

et al. 2016

Braz. J. Pharm. Sci.

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Personal Formularies of Primary Care Physicians Across 4 Health Care Systems

et al. 2021

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IMPORTANCE More conservative prescribing has the potential to reduce adverse drug events and patient harm and cost; however, no method exists defining the extent to which individual clinicians prescribe conservatively. One potential domain is prescribing a more limited number of drugs.Personal formularies-defined as the number and mix of unique, newly initiated drugs prescribed by a physician-may enable comparisons among clinicians, practices, and institutions.OBJECTIVES To develop a method of defining primary care physicians' personal formularies and examine how they differ among primary care physicians at 4 institutions; evaluate associations between personal formularies and patient, physician, and practice site characteristics; and empirically derive and examine the variability of the top 200 core drugs prescribed at the 4 sites. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study was conducted at 4 US health care systems among 4655 internal and family medicine physicians and 4 930 707 patients who had at least 1 visit to these physicians between January 1, 2017, and December 31, 2018. EXPOSURES Personal formulary size was defined as the number of unique, newly initiated drugs. MAIN OUTCOMES AND MEASURESPersonal formulary size and drugs used, physician and patient characteristics, core drugs, and analysis of selected drug classes. RESULTSThe study population included 4655 primary care physicians (2274 women [48.9%]; mean [SD] age, 48.5 [4.4] years) and 4 930 707 patients (16.5% women; mean [SD] age, 51.9 [8.3] years). There were 41 378 903 outpatient prescriptions written, of which 9 496 766 (23.0%) were new starts. Institution median personal formulary size ranged from 150 (interquartile range, 82.0-212.0) to 296 (interquartile range, 230.0-347.0) drugs. In multivariable modeling, personal formulary size was significantly associated with panel size (total number of unique patients with faceto-face encounters during the study period; 1.2 medications per 100 patients), physician's total number of encounters (5.7 drugs per 10% increase), and physician's sex (−6.2 drugs per 100 patients for female physicians). There were 1527 unique, newly prescribed drugs across the 4 sites. Fewer than half the drugs (626 [41.0%]) were used at every site. Physicians' prescribing of drugs from a pooled core list varied from 0% to 100% of their prescriptions.CONCLUSIONS AND RELEVANCE Personal formularies, measured at the level of individual physicians and institutions, reveal variability in size and mix of drugs. Similarly, defining a list of commonly prescribed core drugs in primary care revealed interphysician and interinstitutional differences. Personal formularies and core medication lists enable comparisons and may identify outliers and opportunities for safer and more appropriate prescribing.

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Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals

Abstract: Potentially inappropriate drug prescribing and the omission of beneficial drugs are highly prevalent in acutely ill hospitalized older people in six European centres.

Cited by 289 publications

References 37 publications

Inappropriate prescribing to older patients admitted to hospital: A comparison of different tools of misprescribing and underprescribing

Inappropriate prescribing to older patients admitted to hospital: A comparison of different tools of misprescribing and underprescribing

Exposure to potentially inappropriate medications in Brazilian elderly outpatients with metabolic diseases

Personal Formularies of Primary Care Physicians Across 4 Health Care Systems

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