scholarly journals The PIPc Study—application of indicators of potentially inappropriate prescribing in children (PIPc) to a national prescribing database in Ireland: a cross-sectional prevalence study

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e022876 ◽  
Author(s):  
Emma Barry ◽  
Frank Moriarty ◽  
Fiona Boland ◽  
Kathleen Bennett ◽  
Susan M Smith
Keyword(s):  
Primary Care ◽  
Inappropriate Prescribing ◽  
Cross Sectional Study ◽  
Potentially Inappropriate Prescribing ◽  
Cross Sectional ◽  
Outcomes Measures ◽  
Pharmacy Claims ◽  
Children With Asthma ◽  
Quality Of Prescribing ◽  
Study Application

ObjectivesEvidence is limited regarding the quality of prescribing to children. The objective of this study was to apply a set of explicit prescribing indicators to a national pharmacy claims database (Primary Care Reimbursement Service) to determine the prevalence of potentially inappropriate prescribing in children (PIPc) in primary care.Primary and secondary outcomes measuresTo determine the overall prevalence of potentially inappropriate prescribing (PIP) in children in primary care. To examine the prevalence of PIPc by gender.Design and settingCross-sectional study. Application of indicators of commission of PIP and omission of appropriate prescribing to a national prescribing database in Ireland.ParticipantsEligible children <16 years of age who were prescribed medication in 2014.ResultsOverall prevalence of PIPc by commission was 3.5% (95% CI 3.5% to 3.6%) of eligible children <16 years of age who were prescribed medication in 2014. Overall prevalence of PIPc by omission was 2.5% (95% CI 2.5% to 2.6%) which rose to 11.5% (95% CI 11.4% to 11.7%) when prescribing of spacer devices for children with asthma was included. The most common individual PIPc by commission was the prescribing of carbocisteine to children (3.3% of eligible children). The most common PIPc by omission (after excluding spacer devices) was failure to prescribe an emollient to children prescribed greater than one topical corticosteroid (54% of eligible children). PIPc by omission was significantly higher in males compared with females (relative risk (RR) 1.3; 95% CI 1.0 to 1.7) but no different for PIPc by commission (RR 1.0; 95% CI 0.7 to 1.6).ConclusionThis study shows that the overall prevalence of PIP in children is low, although results suggest room for improved adherence to asthma guidelines.

Quality of Prescribing at Primary Care Centers in Saudi Arabia

1996 ◽  
Vol 12 (6) ◽  
pp. 284-288 ◽  
Author(s):  
Tawfik A Khoja ◽  
Sulaiman Ai Al-Shammari ◽  
Mohammad Kamel Farag ◽  
Yagob Al-Mazrou
Keyword(s):  
Primary Care ◽  
Saudi Arabia ◽  
Vital Signs ◽  
Cross Sectional Study ◽  
Upper Respiratory Tract ◽  
Cross Sectional ◽  
Included Patient ◽  
Quality Of Prescribing ◽  
Common Items

Objective: To assess serious prescribing errors, prescribing rate per patient, and ranking of common illnesses and medications prescribed at primary care centers in Saudi Arabia. A proposal for improvement measures will be formulated. Methodology: A cross-sectional study of a randomly selected afternoon shift (4 working h) was carried out on November 1, 1994. All of the 367 physicians working in the health centers in Riyadh, Saudi Arabia participated. All prescriptions issued by physicians during this shift were entered into the study and examined with regard to a number of variables. The variables included patient demographic characteristics, vital signs, the physician's name and center, diagnosis, and prescription items. Demographic variables were excluded from analysis for purposes of confidentiality. Results: During the study period, 11,326 patients were seen, and 6,350 prescriptions were issued (for 20,320 drug entries). The average number of consultations per primary health care (PHC) physician was 30 ± 9. The average number of prescriptions per PHC physician was 17.3 ± 6, for a total of 0.56 prescriptions per patient. Of all prescriptions, 11.6% were found to have at least one error. The average number of drugs per prescription was 3.2 ± 0.4. The average number of drugs per patient was 1.8 ± 0.3. Of all patients, 73% had two or fewer drug items prescribed. Upper respiratory tract infection was the most frequent diagnosis, and accounted for 31.0% of the illnesses seen. Antibiotics, analgesics/antipyretics, and tonics/vitamins were the most common items prescribed (to 16.8%, 15.4%, and 11.8% of the patients, respectively). The most common errors were those considered type B (5.39%), where the pharmacist must contact the physician before dispensing the prescription, and type C (4.59%), where the pharmacist must make a professional decision before dispensing the prescription. Missing drug strength and missing quantity of medication and frequency of dosing were observed in relatively high proportions (3.8% and 3.2%, respectively). Frequency of the daily dose, generic name of the drug, and strength of the drug were the top three missing pieces of information (89.5%, 86%, and 76.3%, respectively). Conclusions: These results represented a challenge and justified setting standards and indicators to ensure the quality of these vital activities of prescribing and dispensing. There is a need to design and implement training programs to improve PHC team prescribing and dispensing skills and establish an accurate system of error reporting.

Potentially inappropriate prescribing in middle-aged adults

2021 ◽  
Vol 60 (1) ◽  
pp. 6-6
Keyword(s):  
Inappropriate Prescribing ◽  
Cross Sectional Study ◽  
Potentially Inappropriate Prescribing ◽  
Sectional Study ◽  
Middle Aged ◽  
Cross Sectional ◽  
Middle Aged Adults

AbstractOverview of: Khatter A, Moriarty F, Ashworth M et al. Prevalence and predictors of potentially inappropriate prescribing in middle-aged adults: a repeated cross-sectional study. Br J Gen Pract. 2021;71:e491–e497.

scholarly journals Medication Prescribing Quality in Australian Primary Care Patients with Chronic Kidney Disease

2020 ◽  
Vol 9 (3) ◽  
pp. 783 ◽  
Author(s):  
Woldesellassie M. Bezabhe ◽  
Alex Kitsos ◽  
Timothy Saunder ◽  
Gregory M. Peterson ◽  
Luke R. Bereznicki ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
General Practice ◽  
Inappropriate Prescribing ◽  
Potentially Inappropriate Prescribing ◽  
Appropriate Prescribing ◽  
Quality Of Prescribing ◽  
Nationally Representative ◽  
Ras Inhibitors

Background: Australian patients with chronic kidney disease (CKD) are routinely managed in general practices with multiple medications. However, no nationally representative study has evaluated the quality of prescribing in these patients. The objective of this study was to examine the quality of prescribing in patients with CKD using nationally representative primary care data obtained from the NPS MedicineWise’s dataset, MedicineInsight. Methods: A cross-sectional analysis of general practice data for patients aged 18 years or older with CKD was performed from 1 February 2016 to 1 June 2016. The study examined the proportion of patients with CKD who met a set of 16 published indicators in two categories: (1) potentially appropriate prescribing of antihypertensives, renin-angiotensin system (RAS) inhibitors, phosphate binders, and statins; and (2) potentially inappropriate prescribing of nephrotoxic medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), at least two RAS inhibitors, triple therapy (an NSAID, a RAS inhibitor and a diuretic), high-dose digoxin, and metformin. The proportion of patients meeting each quality indicator was stratified using clinical and demographic characteristics. Results: A total of 44,259 patients (24,165 (54.6%) female; 25,562 (57.8%) estimated glomerular filtration (eGFR) 45–59 mL/1.73 m2) with CKD stages 3–5 were included. Nearly one-third of patients had diabetes and were more likely to have their blood pressure and albumin-to-creatinine ratio monitored than those without diabetes. Potentially appropriate prescribing of antihypertensives was achieved in 79.9% of hypertensive patients with CKD stages 4–5. The prescribing indicators for RAS inhibitors in patients with microalbuminuria and diabetes and in patients with macroalbuminuria were achieved in 69.9% and 62.3% of patients, respectively. Only 40.8% of patients with CKD and aged between 50 and 65 years were prescribed statin therapy. The prescribing of a RAS inhibitor plus a diuretic was less commonly achieved, with the indicator met in 20.6% for patients with microalbuminuria and diabetes and 20.4% for patients with macroalbuminuria. Potentially inappropriate prescribing of NSAIDs, metformin, and at least two RAS inhibitors were apparent in 14.3%, 14.1%, and 7.6%, respectively. Potentially inappropriate prescribing tended to be more likely in patients aged ≥65 years, living in regional or remote areas, or with socio-economic indexes for areas (SEIFA) score ≤ 3. Conclusions: We identified areas for possible improvement in the prescribing of RAS inhibitors and statins, as well as deprescribing of NSAIDs and metformin in Australian general practice patients with CKD.

scholarly journals Potentially Inappropriate Prescribing and Potential Clinically Significant Drug–Drug Interactions in Older Outpatients: Is There Any Association?

Medicina ◽  
2019 ◽  
Vol 55 (7) ◽  
pp. 332
Author(s):  
Zorica Cvetković ◽  
Aneta Perić ◽  
Silva Dobrić
Keyword(s):  
Drug Interactions ◽  
Inappropriate Prescribing ◽  
Cross Sectional Study ◽  
Potentially Inappropriate Medications ◽  
Potentially Inappropriate Prescribing ◽  
Cross Sectional ◽  
Inappropriate Use ◽  
Inappropriate Drugs ◽  
Stopp Criteria ◽  
Clinically Significant

Background and Objectives: The purpose of the study was to determine the prevalence rate of potentially inappropriate prescribing (PIP), by using the Screening Tool of Older Person’s potentially inappropriate Prescriptions (STOPP) criteria in older outpatients, and its association with potential clinically significant drug–drug interactions (csDDIs). Materials and Methods: A cross-sectional study included 248 outpatients ≥65 years old divided into two groups depending on the presence of csDDIs. For estimating the clinical significance of csDDIs we used Medscape′s "Drug Interaction Checker". We applied the thirty PIP indicators from the STOPP criteria. Results: The presence of PIP (25.00%; all patients) was significantly higher in the group with potential csDDIs compared to the other group (43 vs. 19, respectively; Chi-square test, χ2 = 9.947; p < 0.01). The most common PIP included the inappropriate use of proton pump inhibitors, long acting benzodiazepines, usage of thiazide diuretic in patients with gout, and duplication of therapeutic class. Patients with potential csDDIs had 43 potentially inappropriate medications (PIMs) prescribed. Out of this number, 12 (27.91%) PIMs were identified to participate in potential csDDIs. There was a correlation between the number of medications prescribed and the number of PIMs (ρ = 0.297; p < 0.01) and between the number of PIPs and the number of potential csDDIs (ρ = 0.170; p < 0.01). Conclusions: Older outpatients with potential csDDIs in relation to those with no potential csDDIs had significantly more prescribed drugs in total as well as inappropriate drugs. Almost 30% of these PIMs were included in potential csDDIs.

scholarly journals Prevalence of potentially inappropriate prescriptions in primary care and correlates with mild cognitive impairment

2020 ◽  
Vol 18 (3) ◽  
pp. 2017
Author(s):  
Klejda Harasani ◽  
Delina Xhafaj ◽  
Anxhela Begolli ◽  
Maria C. Olvera-Porcel
Keyword(s):  
Primary Care ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Inappropriate Prescribing ◽  
Multivariate Logistic Regression Analysis ◽  
Cross Sectional Study ◽  
Western Balkans ◽  
Cross Sectional ◽  
Middle Income ◽  
Inappropriate Prescriptions

Background: Potentially inappropriate prescribing is clearly associated with adverse health consequences among older people. Nevertheless, scarce evidence exists regarding the prevalence of potentially inappropriate prescriptions (PIP) in Albania, a Western Balkans country. Objective: The aim of this study was to assess the prevalence of PIP among older Albanian patients in primary care and to determine the associated sociodemographic and medical factors, including the presence of mild cognitive impairment (MCI). Methods: Cross-sectional study in two primary healthcare centers located in two different cities of Albania, a middle-income country in the Western Balkans. The Montreal Cognitive Assessment (MoCA) tool was applied to evaluate MCI. PIPs were assessed by two trained pharmacists using the Beers criteria 2019 update. Multivariate logistic regression analysis was conducted for possible risk factors predicting PIP in the study population. Results: At least one PIP was identified among 40.23 % of the participants (174 older patients) and 10.35 % had more than one PIP. MCI was detected among 79.31 % of the patients. The most commonly represented drug groups in PIP were diuretics (24.71 %), benzodiazepines in the presence of MCI and antidepressants (both 8.62 %). The lack of electrolytes monitoring was the most common reason for PIP. According to the multivariate analysis, the only statistically significant association observed was between PIP and number of drugs prescribed [three to four drugs (OR 3.34; 95% CI 1.65:6.76), five or more than five drugs (OR 4.08; 95% CI 1.42:11.69)]. Conclusions: About four out of 10 older Albanian patients experience PIP in primary care. Further studies are needed for a comprehensive estimation of the prevalence and factors associated with PIP, particularly among elderly with mild cognitive impairment.

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