Study examines inappropriate medication prescribing for elderly patients

08/05/04

CHICAGO Prescribing of inappropriate medications for elderly patients appears relatively common, according to an article in the August 9/23 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

According to information in the article, persons 65 years or older make up less than 15 percent of the population, but make up nearly one-third of prescription drug users. Elderly persons are also more likely to take several drugs concurrently, the article states.

Lesley H. Curtis, Ph.D., of Duke University Medical Center, Durham, N.C., and colleagues investigated the extent of potentially inappropriate medication prescribing for elderly patients not in the hospital. Inappropriate medications were identified according to criteria set by physicians and pharmacologists, as defined by a list known as the Beers revised list of drugs a list of drugs to be avoided in the elderly.

The researchers studied the outpatient claims database of a large national pharmaceutical benefit company. The database included 765,423 patients aged 65 or older who filled one or more prescription drug claims during 1999.

The researchers found that 162,370 patients (21 percent) filled a prescription for one or more drugs of concern (medications that should be avoided in elderly patients or which are inappropriate for use in elderly patients). Amitriptyline and doxepin (drugs used for treatment of depression) accounted for 23 percent of claims for Beers list drugs, and 51 percent of those claims were for drugs with potentially harmful effects. More than 15 percent of patients filled prescriptions for two drugs of concern, and 4 percent filled prescriptions for three or more drugs of concern within the same year.

"The common use of potentially inappropriate drugs should serve as a reminder to monitor their use closely," the authors write. "Pharmaceutical claims databases can be important tools for accomplishing this task, though clinical and laboratory data are needed to improve the sensitivity and specificity of patient-specific alerts."

(Arch Intern Med. 2004;164:1621-1625. Available post-embargo at http://www.archinternmed.com). Editor's Note: This work was supported by a Centers for Education and Research on Therapeutics cooperative agreement between the Agency for Healthcare Research and Quality, Rockville, Md., and the University of Arizona Health Sciences Center, Tuscon.

Editorial: The Time to Act Is Now

In an accompanying editorial, Knight Steel, M.D., of Hackensack University Medical Center, New Jersey, writes that the article by Curtis et al, "bespeaks a significant failure in the American health care system. Using a 1999 claims database of over three quarters of a million elderly subjects from a national pharmaceutical benefit manager, they report that 21 percent of this population filled a prescription for a drug deemed to be potentially inappropriate for this age group by an expert panel. Although the drugs included on such a list may vary depending on the views of the members of the panel, if even half that number of elderly subjects are taking potentially inappropriate medications, one in ten of all older persons is receiving a drug that is potentially not appropriate."

Dr. Steel states that whatever the reason for the high rates of inappropriate prescribing to elderly patients, "the time has come to decrease the likelihood of inappropriate prescribing."

"One way to begin is to include pharmacists in the process of prescription writing in a more meaningful way. Since they usually have information about patients' age, pharmacists could be required to question the use of certain drugs or dosages in the elderly."

Dr. Steel suggests, "Perhaps the easiest and likely the best way of lowering the number of inappropriate prescriptions would be to design a computer program available to all pharmacists that identified all inappropriate prescriptions."

(Arch Intern Med. 2004;164:1603-1604. Available post-embargo at http://www.archinternmed.com)

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