Potentially inappropriate prescribing to older patients in primary care in the Netherlands: a retrospective longitudinal study

Abstract Objective To 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. Design Longitudinal study of retrospectively extracted data from general practice records. Setting 44 general practices in Ireland in 2012-15. Participants Adults aged 65 years or over attending participating practices. Exposure Admission to hospital (any hospital admission versus none, and post-admission versus pre-admission). Main outcome measures Prevalence 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. Results Overall 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). Conclusion Hospital 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.

Download Full-text

Sustained effectiveness of a multifaceted intervention to reduce potentially inappropriate prescribing in older patients in primary care (OPTI-SCRIPT study)

Implementation Science ◽

10.1186/s13012-016-0442-2 ◽

2015 ◽

Vol 11 (1) ◽

Cited By ~ 7

Author(s):

Barbara Clyne ◽

◽

Susan M. Smith ◽

Carmel M. Hughes ◽

Fiona Boland ◽

...

Keyword(s):

Primary Care ◽

Older Patients ◽

Inappropriate Prescribing ◽

Multifaceted Intervention ◽

Potentially Inappropriate Prescribing

Download Full-text

Effectiveness of medicines review with web-based pharmaceutical treatment algorithms in reducing potentially inappropriate prescribing in older people in primary care: a cluster randomized trial (OPTI-SCRIPT study protocol)

Trials ◽

10.1186/1745-6215-14-72 ◽

2013 ◽

Vol 14 (1) ◽

pp. 72 ◽

Cited By ~ 18

Author(s):

Barbara Clyne ◽

Marie C Bradley ◽

Susan M Smith ◽

Carmel M Hughes ◽

Nicola Motterlini ◽

...

Keyword(s):

Primary Care ◽

Older People ◽

Randomized Trial ◽

Inappropriate Prescribing ◽

Cluster Randomized Trial ◽

Potentially Inappropriate Prescribing ◽

Pharmaceutical Treatment ◽

Web Based ◽

Treatment Algorithms ◽

Cluster Randomized

Download Full-text

Magnitude of Potentially Inappropriate Prescribing in Germany Among Older Patients with Generalized Anxiety Disorder

Social Work and Geriatric Services ◽

10.1201/b13135-6 ◽

2011 ◽

pp. 75-88

Author(s):

Ariel Berger ◽

Marko Mychaskiw ◽

Ellen Dukes ◽

John Edelsberg ◽

Gerry Oster

Keyword(s):

Anxiety Disorder ◽

Generalized Anxiety Disorder ◽

Older Patients ◽

Inappropriate Prescribing ◽

Generalized Anxiety ◽

Potentially Inappropriate Prescribing

Download Full-text

Detection of potentially inappropriate prescribing in older patients with the GheOP³S-tool: completeness and clinical relevance

Acta Clinica Belgica ◽

10.1080/17843286.2019.1568353 ◽

2019 ◽

Vol 74 (2) ◽

pp. 126-136 ◽

Cited By ~ 4

Author(s):

C. Kympers ◽

E. Tommelein ◽

Ellen Van Leeuwen ◽

K. Boussery ◽

M. Petrovic ◽

...

Keyword(s):

Clinical Relevance ◽

Older Patients ◽

Inappropriate Prescribing ◽

Potentially Inappropriate Prescribing

Download Full-text

Potentially inappropriate prescribing in older hospitalized Dutch patients according to the STOPP/START criteria v2: a longitudinal study

European Journal of Clinical Pharmacology ◽

10.1007/s00228-020-03052-2 ◽

2020 ◽

Author(s):

Birgit A. Damoiseaux-Volman ◽

Stephanie Medlock ◽

Kimmy Raven ◽

Danielle Sent ◽

Johannes A. Romijn ◽

...

Keyword(s):

Longitudinal Study ◽

Older Patients ◽

Hospital Admissions ◽

Inappropriate Medication ◽

Inappropriate Prescribing ◽

Patient Characteristics ◽

Start Criteria ◽

High Prevalence ◽

Inappropriate Prescriptions ◽

Over Time

Abstract Purpose To investigate prevalence, independent associations, and variation over time of potentially inappropriate prescriptions in a population of older hospitalized patients. Methods A longitudinal study using a large dataset of hospital admissions of older patients (≥ 70 years) based on an electronic health records cohort including data from 2015 to 2019. Potentially inappropriate medication (PIM) and potential prescribing omission (PPO) prevalence during hospital stay were identified based on the Dutch STOPP/START criteria v2. Univariate and multivariate logistic regression were used for analyzing associations and trends over time. Results The data included 16,687 admissions. Of all admissions, 56% had ≥ 1 PIM and 58% had ≥ 1 PPO. Gender, age, number of medications, number of diagnoses, Charlson score, and length of stay were independently associated with both PIMs and PPOs. Additionally, number of departments and number of prescribing specialties were independently associated with PIMs. Over the years, the PIM prevalence did not change (OR = 1.00, p = .95), whereas PPO prevalence increased (OR = 1.08, p < .001). However, when corrected for changes in patient characteristics such as number of diagnoses, the PIM (aOR = 0.91, p < .001) and PPO prevalence (aOR = 0.94, p < .001) decreased over the years. Conclusion We found potentially inappropriate prescriptions in the majority of admissions of older patients. Prescribing relatively improved over time when considering complexity of the admissions. Nevertheless, the high prevalence shows a clear need to better address this issue in clinical practice. Studies seeking effective (re)prescribing interventions are warranted.

Download Full-text