Use of Inappropriate Prescription Drugs by Older People

Hanlon, Joseph T.; Schmader, Kenneth E.; Boult, Chad; Artz, Margaret B.; Gross, Cynthia R.; Fillenbaum, Gerda G.; Ruby, Christine M.; Garrard, Judith

doi:10.1046/j.1532-5415.2002.50004.x

Cited by 141 publications

(86 citation statements)

References 32 publications

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“…The drugs with the highest overall rates of use in the VA sample included diphenhydramine (3.3%), propoxyphene (3.0%), amitriptyline (2.4%), hydroxyzine (2.4%), and diazepam (1.7%). The overall rate of 21.3% is consistent with prior studies [3][4][5][6][7]15 but remains high. An important finding is that the difference in rates between the private sector HMO and VA cohorts in the always avoid (5.1% vs. 1.5%) and rarely appropriate (13.4% vs. 7.6%) classifications were significantly lower in the VA health system.…”

Section: ■■ Discussionsupporting

confidence: 81%

Comparison of Rates of Potentially Inappropriate Medication Use According to the Zhan Criteria for VA Versus Private Sector Medicare HMOs

Barnett

Perry²,

Langstaff³

et al. 2006

JMCP

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Section: ■■ Discussionsupporting

confidence: 81%

Comparison of Rates of Potentially Inappropriate Medication Use According to the Zhan Criteria for VA Versus Private Sector Medicare HMOs

Barnett

Perry²,

Langstaff³

et al. 2006

JMCP

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“…[1][2][3][4][5] Drug-disease interaction and chronicity of use are two other common problems associated with benzodiazepine use in this population. 6 As Oude Voshaar et al 7 point out, there is limited evidence suggesting the long-term efficacy in two specific diagnostic groups: panic disorder and social phobia, and the prevalence of these specific disorders among those who are long-term users is relatively low. Indeed, many community-residing older long-term benzodiazepine users do not have any mental health problem.…”

Section: Introductionmentioning

confidence: 99%

Older Patient Perspectives on Long-Term Anxiolytic Benzodiazepine Use and Discontinuation: A Qualitative Study

et al. 2007

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OBJECTIVE:The objective of the study is to understand patient factors contributing to the chronicity of benzodiazepine use by older adults as a first step in the development of acceptable intervention strategies for taper/discontinuation or prevention of chronic use. DESIGN:The design of the study consists of qualitative semi-structured patient interviews. SETTING AND PARTICIPANTS:The participants were 50 anxiolytic benzodiazepine users, 61-95 years of age, recruited through referrals from primary care physicians who practiced in the general Philadelphia, Pennsylvania area.RESULTS: Many older chronic users have come to rely and psychologically depend on benzodiazepines for their unique soothing properties, attributing to these medications characteristics that extend beyond an ordinary medication, i.e., affording control over daily stress, bringing tranquility, and even prolonging life. Most of the patients denied or minimized side effects and expressed resistance to taper or discontinuation, ranging from subtle reluctance to outright refusal and fear of being left suffering without these medications. CONCLUSIONS:The reluctance of older chronic benzodiazepine users to taper or discontinue use highlights the importance of prevention and early intervention strategies to avoid the development of chronic use. Suggestions for curbing chronic use are presented.

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“…Data from 687 patients were collected (average 8.7 pts./pharmacy, range [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. The characteristics of these patients are presented in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Disease and Intolerability Documentation in Electronic Patient Records

et al. 2005

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BACKGROUND: Documentation of diseases and intolerabilities in electronic patient records (EPRs) in pharmacies is needed to produce an alert in case a contraindicated medicine is prescribed. Limited research is available concerning EPRs in pharmacies. Objective: To study the prevalence and quality of documentation of diseases and intolerabilities in EPRs in a sample of Dutch community pharmacies. METHODS: Each participating pharmacy (N = 79) collected data on one day in May 2003 for each patient enrolled into the study (N = 687) concerning demographics, drug use, and documentation of diseases and intolerabilities. RESULTS: In 57.4% of the EPRs, at least one disease and, in 7.9%, at least one intolerability was documented. Higher age, number of drugs used, and chronic disease score were associated with any documentation of a disease/intolerability in the EPR. The highest sensitivity scores (completeness) were found for diabetes (84.7%), asthma/chronic obstructive pulmonary disease (strict definition: 75.9%), and hypothyroidism (75.0%). Rather low values were found for prostatic hyperplasia (55.6%) and heart failure (29.4%). The positive predictive value (reliability) was high for hypothyroidism (100%) and diabetes (87.1%). CONCLUSIONS: In a selection of Dutch pharmacies, at least one documented disease and/or intolerability was found in the EPR of almost 60% of the patients. Certain diseases were documented to a relatively high degree; others had poorer levels of documentation. For optimal surveillance of drug–disease interactions in pharmacies, the frequency and quality of disease and intolerability documentation need further improvement.

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Use of Inappropriate Prescription Drugs by Older People

Abstract: These results indicate that inappropriate prescribing is common among community-dwelling older people and persists over time. Longitudinal studies in older people are needed to examine the impact of inappropriate drug prescribing on health-related outcomes.

Cited by 141 publications

References 32 publications

Comparison of Rates of Potentially Inappropriate Medication Use According to the Zhan Criteria for VA Versus Private Sector Medicare HMOs

Comparison of Rates of Potentially Inappropriate Medication Use According to the Zhan Criteria for VA Versus Private Sector Medicare HMOs

Older Patient Perspectives on Long-Term Anxiolytic Benzodiazepine Use and Discontinuation: A Qualitative Study

Disease and Intolerability Documentation in Electronic Patient Records

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