Dataset Information

Prevalence of potentially inappropriate prescribing in older people in primary care and its association with hospital admission: 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.

SUBMITTER: Perez T

PROVIDER: S-EPMC6233705 | biostudies-other | 2018 Nov

REPOSITORIES: biostudies-other

ACCESS DATA

Publications

Prevalence of potentially inappropriate prescribing in older people in primary care and its association with hospital admission: longitudinal study.

Pérez Teresa T Moriarty Frank F Wallace Emma E McDowell Ronald R Redmond Patrick P Fahey Tom T

BMJ (Clinical research ed.) 20181114

<h4>Objective</h4>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.<h4>Design</h4>Longitudinal study of retrospectively extracted data from general practice records.<h4>Setting</h4>44 general practices in Ireland in 2012-15.<h4>Participants</h4>Adults aged 65 years or over attending participating practices.<h4>Exposur ...[more]

PMID: 30429122

Similar Datasets

Project description:BACKGROUND:Potentially inappropriate prescribing (PIP) is associated with negative health outcomes, including hospitalisation and mortality. Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ) is a longitudinal study of M?ori (the indigenous population of New Zealand) and non-M?ori octogenarians. Health disparities between indigenous and non-indigenous populations are prevalent internationally and engagement of indigenous populations in health research is necessary to understand and address these disparities. Using LiLACS NZ data, this study reports the association of PIP with hospitalisations and mortality prospectively over 36-months follow-up. METHODS:PIP, from pharmacist applied criteria, was reported as potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs). The association between PIP and hospitalisations (all-cause, cardiovascular disease-specific and ambulatory-sensitive) and mortality was determined throughout a series of 12-month follow-ups using binary logistic (hospitalisations) and Cox (mortality) regression analysis, reported as odds ratios (ORs) and hazard ratios (HRs), respectively, and the corresponding confidence intervals (CIs). RESULTS:Full demographic data were obtained for 267 M?ori and 404 non-M?ori at baseline, 178 M?ori and 332 non-M?ori at 12-months, and 122 M?ori and 281 non-M?ori at 24-months. The prevalence of any PIP (i.e. ?1 PIM and/or PPO) was 66, 75 and 72% for M?ori at baseline, 12-months and 24-months, respectively. In non-M?ori, the prevalence of any PIP was 62, 71 and 73% at baseline, 12-months and 24-months, respectively. At each time-point, there were more PPOs than PIMs; at baseline M?ori were exposed to a significantly greater proportion of PPOs compared to non-M?ori (p =?0.02). In M?ori: PPOs were associated with a 1.5-fold increase in hospitalisations and mortality. In non-M?ori, PIMs were associated with a double risk of mortality. CONCLUSIONS:PIP was associated with an increased risk of hospitalisation and mortality in this cohort. Omissions appear more important for M?ori in predicting hospitalisations, and PIMs were more important in non-M?ori in predicting mortality. These results suggest understanding prescribing outcomes across and between population groups is needed and emphasises prescribing quality assessment is useful.

Dataset Information

Prevalence of potentially inappropriate prescribing in older people in primary care and its association with hospital admission: longitudinal study.

Publications

Prevalence of potentially inappropriate prescribing in older people in primary care and its association with hospital admission: longitudinal study.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets