The Association of Inappropriate Drug Use with Hospitalisation and Mortality

Klarin, Inga; Wimo, Anders; Fastbom, Johan

doi:10.2165/00002512-200522010-00005

Cited by 259 publications

(196 citation statements)

References 44 publications

Supporting

Mentioning

165

Contrasting

Unclassified

Order By: Relevance

“…In a study of 211 Medicare enrollees, Rask et al (2005) found that PIMs were not associated with DRP; indeed, the majority of DRPs in this study occurred in persons prescribed non-PIMs. Researchers in several recent controlled studies, however, have begun to show a link with the Beers criteria and poorer patient outcomes (Klarin, Wimo, & Fastbom, 2005;Lau et al, 2004). Lau et al found PIM use was associated with increased risk of hospitalization and increased risk of deaths among NH residents.…”

Section: Discussionmentioning

confidence: 99%

Health outcomes associated with potentially inappropriate medication use in older adults

Fick

Mion

Beers

et al. 2007

Research in Nursing & Health

245

188

View full text Add to dashboard Cite

The purpose of this study was to examine the prevalence of potentially inappropriate medication use (PIMs) among community-dwelling older adults and the association between PIMs and health care outcomes. Participants were 17,971 individuals age 65 years and older. PIM use was defined by the Beers criteria. Drug-related problems (DRPs) were defined using ICD-9 codes. Forty percent of the 17,971 individuals filled at least 1 PIM prescription, and 13% filled 2 or more PIM prescriptions. Overall DRP prevalence among those with at least 1 PIM prescription was 14.3% compared to 4.7% in the non-PIM group (p < .001). In conclusion, preventing PIM use may be important for decreasing medication-related problems, which are increasingly being recognized as requiring an integrated interdisciplinary approach. Keywordsmedications; healthcare costs; geriatrics; adverse drug events Drug-related problems (DRPs) are prevalent in the older adult population and pose a major patient safety concern. DRPs arise because of the increasing number of medications required by this age group, fragmented systems of care, pre-existing health conditions, and the pharmacokinetic and pharmacodynamic changes that occur with aging (Bigos, Bies, & Pollock, 2006;Cusack, 2004;Gurwitz, 2004;Hajjar et al., 2003;Turnheim, 2004Turnheim, , 2005. Avoiding use of high-risk drugs is an important strategy in reducing DRPs. The purpose of this study was to examine both the prevalence of potentially inappropriate medication (PIMs) use among community-dwelling older adults and the association between PIMs and health care outcomes.One method promoted to identify high-risk medications is the use of an explicit list of PIMs. PIMs were first devised and publicized by Beers et al. for nursing home residents and subsequently expanded to include older adults in all settings (Beers, 1997). PIMs are medications identified through expert panel review as having risks that outweigh benefits (Beers et al., 1991). Since the early 1990s, the prevalence of PIMs has been examined in a (Lau, Kasper, Potter, & Lyles, 2004), outpatient (Aparasu & Sitzman, 1999Curtis et al., 2004), acute care (Onder et al., 2005), and community settings (Zhan et al., 2001). For research purposes, use of explicit criteria is generally preferred over the use of implicit criteria applied by expert reviewers.The clinical validity of using a list of medications based on expert panel review and explicit criteria has been questioned as being overly simplistic and not including all the common drugs causing problems in older adults (Crownover & Unwin, 2005;Shorr, 2004). Moreover, despite the numerous reports of the prevalence of PIMs, only a few investigators (Fu, Liu, & Christensen, 2004;Thapa, Gideon, Cost, Milam, & Ray, 1998) have examined whether PIMs are associated with adverse clinical outcomes. Therefore, we investigated the outcomes associated with PIM use in a population of community-dwelling older adults.The Beers criteria have been revised recently; hence, the current prevalence of PIMs in...

show abstract

Section: Discussionmentioning

confidence: 99%

Health outcomes associated with potentially inappropriate medication use in older adults

Fick

Mion

Beers

et al. 2007

Research in Nursing & Health

245

188

View full text Add to dashboard Cite

show abstract

“…18 Psychotropic prescription was considered 'inappropriate' if a condition known to increase the risk of an adverse reaction was present: (i) use of a long-acting benzodiazepine; 19 (ii) benzodiazepine prescription for more than 3 months; 17,20,21 and/or (iii) concomitant use of three or more psychotropic drugs. 22,23 Statistical analyses were performed using the statistical package R-2.6.1. Frequency distribution, cross-tabulation, and χ 2 tests were used to analyse categorical data.…”

Section: How This Fits Inmentioning

confidence: 99%

Psychotropic drug use among older people in general practice: discrepancies between opinion and practice

Lasserre

Younès

Blanchon³

et al. 2010

Br J Gen Pract

View full text Add to dashboard Cite

The use of psychotropic drugs has increased over recent years in France. GPs are the first prescribers, especially for older patients. AimTo analyse discrepancies between GPs' opinions and practice when prescribing psychotropic drugs to older patients. SettingPostal surveys sent to GPs all over mainland France. Design of studyCross-sectional postal study. MethodA questionnaire collected data on characteristics of GPs' practices, their opinions about psychotropic drug consumption in older people, and a full description of their last older patient receiving a psychotropic drug and seen last by the GP on that particular day. ResultsA total of 350 participating GPs saw 2498 patients aged ≥65 years. Among these patients, the prevalence of psychotropic use was 32.1% (803/2498) for anxiolytics/hypnotics, and 17.5% for antidepressants (438/2498). A total of 91% of GPs agreed that it was possible to reduce or stop psychotropic drugs for these patients. Characteristics of 339 patients taking psychotropic drug were reported: 85.8% (291/339) received at least one anxiolytic/hypnotic and 56.9% (193/339) received at least one antidepressant; there were prescribed for more than 1 year in 68.4% (199/291) and 43.5% (84/193) of the cases respectively. GPs stated that it was possible to reduce or stop anxiolytic/hypnotic drugs for only 27% (79/291) of these patients. Barriers to doing this were patients' refusal (79%), and the absence of any local offer of psychotherapy (73%) or alternative therapy (70%). ConclusionA mismatch exists between GPs' intent (91%) and practice (27%) regarding reduction of psychotropic prescription in individuals aged ≥65 years. The barriers encountered should be examined further to help physicians improve management of psychotropic prescription.

show abstract

“…The proposal is based on Swedish recommendations, internationally published explicit criteria and expert opinions. This indicator has been used in several research studies [9,[18][19][20][21][22][23] as well as in recent national assessments of quality and efficiency in the Swedish healthcare system [24]. The indicator is considered to be a proxy for polypharmacy (concurrent use of multiple drugs) and to signal poor quality in the treatment of psychiatric disorders.…”

Section: Introductionmentioning

confidence: 99%

To what extent does the indicator “concurrent use of three or more psychotropic drugs” capture use of potentially inappropriate psychotropics among the elderly?

Lesén

Petzold

Andersson

et al. 2009

Eur J Clin Pharmacol

View full text Add to dashboard Cite

Purpose The indicator "concurrent use of three or more psychotropic drugs" has been used as a measure of quality in drug use among the elderly. The aim of our study was to assess to what extent the indicator captures the use of specific psychotropics associated with an increased risk of adverse events among the elderly, i.e., potentially inappropriate psychotropic drugs (PIP). Methods All individuals aged 75 years and older in Sweden purchasing prescribed psychotropic drugs in 2006 constituted the study population (n=384,904). Data on purchased psychotropic drugs from the Swedish Prescribed Drug Register were used. The overlap between individuals with the indicator and individuals using PIP was assessed with sensitivity, specificity, positive and negative predictive values and likelihood ratio as outcome measures. Results Among the psychotropic drug users, 15% had the indicator and 39% used PIP. The proportion of individuals with the indicator among all individuals using PIP was 27% (sensitivity). The proportion of individuals without the indicator among all individuals not using PIP was 93% (specificity). The positive predictive value was 72%, and the negative predictive value was 67%. Differences in outcome measures were observed between different categories of PIP. Conclusions The indicator "concurrent use of three or more psychotropics" can be technically easy to use, but PIP is more specific. Three quarters of all individuals who used PIP in this study were not captured by the indicator.However, two thirds of all individuals with the indicator used PIP. When selecting instruments to assess appropriateness in drug therapy in the elderly, clinical relevance should be balanced against convenience of use.

show abstract

The Association of Inappropriate Drug Use with Hospitalisation and Mortality

Cited by 259 publications

References 44 publications

Health outcomes associated with potentially inappropriate medication use in older adults

Health outcomes associated with potentially inappropriate medication use in older adults

Psychotropic drug use among older people in general practice: discrepancies between opinion and practice

To what extent does the indicator “concurrent use of three or more psychotropic drugs” capture use of potentially inappropriate psychotropics among the elderly?

Contact Info

Product

Resources

About