Suboptimal Prescribing in Older Inpatients and Outpatients

Abstract

Investigators searched Medline and HealthSTAR databases from January 1, 1985 through June 30, 1999 to identify articles on suboptimal prescribing in those age 65 years and older. A manual search of the reference lists from identified articles and the authors' article files, book chapters, and recent reviews was conducted to identify additional articles. The definitions for various types of suboptimal prescribing (polypharmacy, inappropriate, and underutilization) are numerous, and measurement varies from study to study. The literature suggests that suboptimal prescribing is common in older outpatients and inpatients. Moreover, there is significant morbidity and mortality associated with suboptimal prescribing for these older patients. Evidence from well-controlled studies suggests that multidisciplinary teams and clinical pharmacy interventions can modify suboptimal drug use in older people. Future research is necessary to measure and test other methods for tackling this major public health problem facing older people.

Combined intervention programme reduces inappropriate prescribing in elderly patients exposed to polypharmacy in primary care

“…The authors explained the lack of effect on the fact that they used a single intervention aimed at the GPs, which is a very plausible explanation considering the number of papers published relating to the effect of interventions in general. Several authors of reviews on the area have found that multifaceted interventions seem to be more effective than single interventions [25][26][27][28][29]. Indeed, our study failed to show any effect of the single intervention, the interactive educational meeting.…”

“…The scale of the problem is difficult to assess due to limitations associated with the selection of a standard and publication bias [16][17][18]. Improving medication use would have important financial and public health benefits, and many attempts have been made to find methods of improving the quality of prescribing in various settings [19][20][21]. However, only a limited number of well-controlled studies have examined the effect of different strategies on prescribing quality in primary care.…”

Atuação da Estratégia Saúde da Família e do Núcleo de Apoio à Saúde da Família no uso racional de medicamentos em Rio Fortuna, em Santa Catarina

“…Estima-se que 23% da população brasileira consomem 60% da produção nacional de medicamentos, principalmente as pessoas acima de 60 anos 16 . Há evidências de que os idosos norte--americanos, vivendo na comunidade, ingerem, em média, de 2,7 a 4,2 medicamentos por dia 17 . Marin et al 18 consideram que os idosos que utilizam múltiplos medicamentos são propensos à maior vulnerabilidade nas condições de saúde e que, em média, pessoas que usam cinco ou mais medicamentos revelam 5,2 diagnósticos, por idoso.…”

Inappropriate prescribing, non-adherence to long-term medications and related morbidities : Pharmacoepidemiological aspects

“…NSAIDs as analgesics when only treatment with paracetamol is sufficient 4 Opioids without indication of pain or without first line of mild pain killers Antipsychotics without existence of indication (psychotic syndrome, severe aggression) 5 Proton pomp inhibitor (PPI) without appropriate indication (Ulcer disease, Gastro-esophageal reflux disease (GERD), or prophylaxis with NSAIDs)…”