Half of older patients exposed to inappropriate prescribing

According to research published by the BMJ, approximately half of patients over the age of 65 are exposed to inappropriate prescribing

According to the BMJ, around half of older patients (65+) are exposed to potentially inappropriate prescribing every year.

Inappropriate prescribing can include the intensification of existing drugs and the failure to stop – or reduce – doses of certain drugs after discharge from hospital.

The findings from the report into this subject – available to read on the BMJ website – suggest that better coordination of care is needed to reduce avoidable medication related harms among these patients.

Inappropriate prescribing is associated with adverse outcomes including emergency hospital attendances and admissions, adverse drug events and poorer quality of life.

Research to date has focused on characteristics of patients and general practitioners as risk factors for poor prescribing quality. There has been less focus on how health system factors, such as hospital admission or care transitions, may contribute to the appropriateness of prescribing for these patients – until now.

This research, led by Tom Fahey at the Royal College of Surgeons in Ireland, in collaboration with the Department of Statistics and Data Science, Complutense University of Madrid, set out to determine whether hospital admission is associated with potentially inappropriate prescribing among older primary care patients and whether such prescribing was more likely after hospital admission than before.

The team analysed data from 44 general practices in Ireland from 2012 to 2015, with a total of 38,229 patients living in the community were included in the analyses. The average age was 77 years; 43% were male and 10-15% of patients had at least one hospital admission each year.

Rates of potentially inappropriate prescribing were assessed using 45 criteria from the Screening Tool for Older Persons’ Prescription (STOPP). The overall level of potentially inappropriate prescribing ranged from 45.3% of patients in 2012 to 51% in 2015.

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Irrespective of age, sex, number of prescription items, other conditions, and health cover, hospital admission was associated with a higher rate of potentially inappropriate prescribing.

The researchers say that hospital admission is “an important driver of potentially inappropriate prescribing and the overuse and/or misuse of drugs.”

They are calling for better coordination of care, particularly for older patients with complex care needs, to help reduce risk of medication errors, adverse drug events and readmissions.

“Identifying optimal management strategies for older people is vital to ensure that the risk of inappropriate drugs is minimised after transitions of care,” they conclude.

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