Dataset Information

Patient factors associated with new prescribing of potentially inappropriate medications in multimorbid US older adults using multiple medications.

ABSTRACT:

Background

The use of potentially inappropriate medications (PIMs) is common in older adults and is associated with potential negative consequences, such as falls and cognitive decline. Our objective was to investigate measurable patient factors associated with new outpatient prescribing of potentially inappropriate medications in older multimorbid adults already using multiple medications.

Methods

In this retrospective US cohort study, we used linked Medicare pharmacy and medical claims and electronic health record data from a large healthcare system in Massachusetts between 2007 and 2014. We identified patients aged ?65?years with an office visit who had not been prescribed or used a PIM in the prior 180?days. PIMs were defined using 2019 Beers criteria of the American Geriatrics Society. To specifically evaluate factors in patients with polypharmacy and multimorbidity, we selected those who filled medications for ?90?days (i.e., chronic use) from ?5 pharmaceutical classes in the prior 180?days and had ?2 chronic conditions. Multivariable Cox regression analysis was used to estimate the association between baseline demographic and clinical characteristics on the probability of being prescribed a PIM in the 90-day follow-up period.

Results

In total, we identified 17,912 patients aged ?65?years with multimorbidity and polypharmacy who were naïve to a PIM in the prior 180?days. Of those, 10,497 (58.6%) were female, and mean age was 78 (SD?=?7.5). On average, patients had 5.1 (SD?=?2.3) chronic conditions and previously filled 6.1 (SD?=?1.4) chronic medications. In total, 447 patients (2.5%) were prescribed a PIM during the 90-day follow-up. Male sex (adjusted hazard ratio (HR)?=?1.29; 95%CI: 1.06-1.57), age (?85?years: HR?=?0.75, 95%CI: 0.56-0.99, 75-84 years: HR?=?0.87, 95%CI: 0.71-1.07; reference: 65-74 years), ambulatory visits (18-29 visits: HR?=?1.42, 95%CI: 1.06-1.92; ?30 visits: HR?=?2.12, 95%CI: 1.53-2.95; reference: ?9 visits), number of prescribing orders (HR?=?1.02, 95%CI: 1.01-1.02 per 1-unit increase), and heart failure (HR?=?1.38, 95%CI: 1.07-1.78) were independently associated with being newly prescribed a PIM.

Conclusion

Several demographic and clinical characteristics, including factors suggesting lack of care coordination and increased clinical complexity, were found to be associated with the new prescribing of potentially inappropriate medications. This knowledge could inform the design of interventions and policies to optimize pharmacotherapy for these patients.

SUBMITTER: Jungo KT

PROVIDER: S-EPMC7937195 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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Patient factors associated with new prescribing of potentially inappropriate medications in multimorbid US older adults using multiple medications.

Jungo Katharina Tabea KT Streit Sven S Lauffenburger Julie C JC

BMC geriatrics 20210306 1

<h4>Background</h4>The use of potentially inappropriate medications (PIMs) is common in older adults and is associated with potential negative consequences, such as falls and cognitive decline. Our objective was to investigate measurable patient factors associated with new outpatient prescribing of potentially inappropriate medications in older multimorbid adults already using multiple medications.<h4>Methods</h4>In this retrospective US cohort study, we used linked Medicare pharmacy and medical ...[more]

PMID: 33676398

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Project description:BackgroundMany medications pose greater health risks when prescribed for older adults, compared with available pharmacologic and nonpharmacologic alternatives. We sought to quantify the frequency and cost of potentially inappropriate prescribing for older women and men in Canada.MethodsUsing data for 2013 from the National Prescription Drug Utilization Information System database, which contains prescription claims from publicly financed drug plans in all provinces except for Quebec, we identified the frequency of prescribing and cost of potentially inappropriate medications dispensed to provincial drug plan enrollees aged 65 years or more. Potentially inappropriate prescriptions were defined with the use of the American Geriatrics Society's 2012 version of the Beers Criteria for potentially inappropriate medication use in older adults.ResultsFor the 6 provinces with relatively complete data coverage (British Columbia, Alberta, Saskatchewan, Manitoba, Ontario and Prince Edward Island), 37% of older people filled 1 or more prescription meeting the Beers Criteria. A higher proportion of women (42%) than men (31%) filled potentially inappropriate prescriptions. The highest rates of prescribing of potentially inappropriate medications were among women aged 85 or more (47%). Benzodiazepines and other hypnotics were the leading contributors to the overall frequency of and sex differences in prescribing of potentially inappropriate drugs among older adults. We estimated that $75 per older Canadian, or $419 million in total, was spent on potentially inappropriate medications outside of hospital settings in 2013.InterpretationPrescribing of potentially inappropriate medications for older adults is common and costly in Canada, especially for women. Multipronged and well-coordinated strategies to reduce the use and cost of potentially inappropriate drugs would likely generate significant health system savings while simultaneously generating major benefits to patient health.

Project description:BackgroundAlthough tramadol is an effective weak opioid analgesic, careful monitoring of potential central nervous system adverse reactions in older adults is needed, especially when used with concomitant medications which may trigger the adverse effects. We aimed to characterize tramadol users with potentially inappropriate co-medications in older adults using a latent class analysis (LCA).MethodPatients aged 65 years or older using tramadol and receiving potentially inappropriate co-medications were included from a nationwide healthcare claims database. We defined antidepressants, first-generation antihistamines, and anxiolytics as potentially inappropriate co-medications. We applied an LCA for grouping tramadol users based on the common characteristics of medication use and healthcare utilization, and each patient was probabilistically assigned to a class. Patients' characteristics in different latent classes were compared. Potential adverse drug reactions (ADRs) was defined as the any visits for emergency department after the occurrence of potentially inappropriate co-medications. Logistic regression analysis was used to examine the association between latent classes and potential ADRs.ResultsWe identified four distinct latent classes of tramadol users representing different patterns of co-medications: multiple potential drug-drug interaction (pDDI) combination users, antihistamines-tramadol users, antidepressants-tramadol users, and anxiolytics-tramadol users. Multiple pDDI combination users showed high proportion of regular tramadol use, tended to visit more medical institutions, and had a high Charlson comorbidity score. The duration of use of potentially inappropriate co-medications with tramadol was the longest in multiple pDDI combination users and the shortest in antihistamines-tramadol users. When compared with antihistamines-tramadol users, increased potential ADR risk was observed in multiple pDDI combination users (adjusted odds ratio (OR), 1.81; 95% confidence interval (CI), 1.75-1.88), antidepressants-tramadol users (1.24; 1.19-1.29), and anxiolytics-tramadol users (1.04; 1.00-1.08).ConclusionsFour distinct classes were identified among older adults using tramadol and potentially inappropriate co-medications. Differences in potential ADR risk were observed between these classes. These findings may help to identify patients at a high risk for ADRs owing to potentially inappropriate co-medications with tramadol.

Dataset Information

Patient factors associated with new prescribing of potentially inappropriate medications in multimorbid US older adults using multiple medications.

Background

Methods

Results

Conclusion

Publications

Patient factors associated with new prescribing of potentially inappropriate medications in multimorbid US older adults using multiple medications.

Similar Datasets

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