Physician and patient-related factors associated with inappropriate prescribing to older patients within primary care
a cross-sectional study in Brazil
Keywords:
Aged, Polypharmacy, Brazil, Prescription drugs, Primary health careAbstract
BACKGROUND: Physician and patient-related characteristics can influence prescription of medicationsto older patients within primary healthcare. Use of Brazilian criteria may indicate the real prevalence of prescription of potentially inappropriate medications to this population. OBJECTIVES: To evaluate prescription of potentially inappropriate medications to older patients within primary care and identify patient-related and prescribing physician-related factors. DESIGN AND SETTING: This cross-sectional study was conducted in 22 public primary care facilities in Brazil, among older people (≥ 60 years) who were waiting for medical consultations. METHODS: Interviews were conducted before and after the medical consultations. If the patient received a medical prescription at the consultation, all the drugs prescribed and the physician’s medical council registration number were recorded. Prevalence ratios were estimated to ascertain the magnitude of prescription of potentially inappropriate medications, along with patient and physician-related factors associated with such prescription. RESULTS: In total, 417 older patients were included; 45.3% had received ≥ 1 potentially inappropriate medication, and 86.8% out of 53 physicians involved had prescribed ≥ 1 potentially inappropriate medication. The strongest patient-related factor associated with higher prevalence of prescription of potentially inappropriate medications was polypharmacy. Among physician-related factors, the number of patients attended, number of prescriptions and length of medical practice < 10 years were positively associated with prescription of potentially inappropriate medications. CONCLUSIONS: High prevalence of prescription of potentially inappropriate medications was observed. Physician-related characteristics can influence prescription of medications to older people within primary healthcare. This suggests that there is a need for interventions among all physicians, especially younger physicians.
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References
Spinewine A, Schmader KE, Barber N, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet. 2007;370(9582):173-84. PMID: 17630041; https://doi.org/10.1016/S0140-6736(07)61091-5.
Opondo D, Eslami S, Visscher S, et al. Inappropriateness of medication prescriptions to elderly patients in the primary care setting: A systematic review. PLoS One. 2012;7(8):e43617. PMID: 22928004; https://doi.org/10.1371/journal.pone.0043617.
Hill-Taylor B, Sketris I, Hayden J, et al. Application of the STOPP/ START criteria: A systematic review of the prevalence of potentially inappropriate prescribing in older adults, and evidence of clinical, humanistic and economic impact. J Clin Pharm Ther. 2013;38(5):360- 72. PMID: 23550814; https://doi.org/10.1111/jcpt.12059.
Oliveira MG, Amorim WW, Oliveira CRB, et al. Consenso Brasileiro de Medicamentos Potencialmente Inapropriados para Idosos [Brazilian consensus of potentially inappropriate medication for elderly people]. Geriatr Gerontol Aging. 2016;10:1-14. https://doi.org/10.5327/Z2447-211520161600054.
Fick DM, Mion LC, Beers MH, L. Waller J. Health outcomes associated with potentially inappropriate medication use in older adults. Res Nurs Health. 2008;31(1):42-51. PMID: 18163447; https://doi.org/10.1002/nur.20232.
Fernández-Regueiro R, Fonseca-Aizpuru E, López-Colina G, et al. Prescripción inadecuada y efectos adversos a medicamentos en pacientes de edad avanzada [Inappropriate Drug Prescription and Adverse Drug Effects in Elderly Patients]. Rev Clin Esp. 2011;211(8):400-6. PMID: 21733501; https://doi.org/10.1016/j.rce.2011.05.004.
Hamilton H, Gallagher P, Ryan C, Byrne S, O’Mahony D. Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients. Arch Intern Med. 2011;171(11):1013-9. PMID: 21670370; https://doi.org/10.1001/archinternmed.2011.215.
Chiatti C, Bustacchini S, Furneri G, et al. The economic burden of inappropriate drug prescribing, lack of adherence and compliance, adverse drug events in older people: a systematic review. Drug Saf. 2012;35 Suppl 1:73-87. PMID: 23446788; https://doi.org/10.1007/BF03319105.
Wallace E, McDowell R, Bennett K, Fahey T, Smith SM. Impact of potentially inappropriate prescribing on adverse drug events, health related quality of life and emergency hospital attendance in older people attending general practice: A prospective cohort study. J Gerontol A Biol Sci Med Sci. 2017;72(2):271-7. PMID: 27466245; https://doi.org/10.1093/gerona/glw140.
Muhlack DC, Hoppe LK, Stock C, et al. The associations of geriatric syndromes and other patient characteristics with the current and future use of potentially inappropriate medications in a large cohort study. Eur J Clin Pharmacol. 2018;74(12):1633–44. PMID: 30159676; https://doi.org/10.1007/s00228-018-2534-1.
Moriarty F, Bennett K, Kenny RA, Fahey T, Cahir C. Comparing potentially inappropriate prescribing tools and their association with patient outcomes. J Am Geriatr Soc. 2020;68(3):526-34. PMID: 31675114; https://doi.org/10.1111/jgs.16239.
Counter D, Millar JWT, McLay JS. Hospital readmissions, mortality and potentially inappropriate prescribing: a retrospective study of older adults discharged from hospital. Br J Clin Pharmacol. 2018;84(8):1757- 63. PMID: 29744901; https://doi.org/10.1111/bcp.13607.
do Nascimento MMG, Mambrini JV de M, Lima-Costa MF, et al. Potentially inappropriate medications: predictor for mortality in a cohort of community-dwelling older adults. Eur J Clin Pharmacol. 2017;73(5):615- 21. PMID: 28108781; https://doi.org/10.1007/s00228-017-2202-x.
Cahir C, Fahey T, Teeling M, et al. Potentially inappropriate prescribing and cost outcomes for older people: A national population study. Br J Clin Pharmacol. 2010;69(5):543–52. PMID: 20573091; https://doi.org/10.1111/j.1365-2125.2010.03628.x.
Morgan SG, Hunt J, Rioux J, et al. Frequency and cost of potentially inappropriate prescribing for older adults: a cross-sectional study. CMAJ Open. 2016;4(2):E346-E351. PMID: 27398383; https://doi.org/10.9778/cmajo.20150131.
Black CD, Thavorn K, Coyle D, Bjerre LM. The health system costs of potentially inappropriate prescribing: a population-based, retrospective cohort study using linked health administrative databases in Ontario, Canada. Pharmacoecon Open. 2020;4(1):27-36. PMID: 31218653; https://doi.org/10.1007/s41669-019-0143-2.
Tommelein E, Mehuys E, Petrovic M, et al. Potentially inappropriate prescribing in community-dwelling older people across Europe: a systematic literature review. Eur J Clin Pharmacol. 2015;71(12):1415-27. PMID: 26407687; https://doi.org/10.1007/s00228-015-1954-4.
Roux B, Sirois C, Simard M, Gagnon ME, Laroche ML. One-year persistence of potentially inappropriate medication use in older adults: A population-based study. Br J Clin Pharmacol. 2020:86(6):1062-80. PMID: 31916266; https://doi.org/10.1111/bcp.14214.
Extavour RM, Perri M 3rd. Patient, physician, and health-system factors influencing the quality of antidepressant and sedative prescribing for older, community-dwelling adults Health Serv Res. 2018;53(1):405-29. PMID: 28024315; https://doi.org/10.1111/1475-6773.12641.
Oliveira MG, Amorim WW, de Jesus SR, Rodrigues VA, Passos LC. Factors associated with potentially inappropriate medication use by the elderly in the Brazilian primary care setting. Int J Clin Pharm. 2012;34(4):626-32. PMID: 22692715; https://doi.org/10.1007/s11096-012-9656-9.
Chang CB, Lai HY, Yang SY, et al. Patient- and clinic visit-related factors associated with potentially inappropriate medication use among older home healthcare service recipients. PLoS One. 2014;9(4):e94350. PMID: 24722537; https://doi.org/10.1371/journal.pone.0094350.
Ie K, Felton M, Springer S, Wilson SA, Albert SM. Physician factors associated with polypharmacy and potentially inappropriate medication use. J Am Board Fam Med. 2017;30(4):528-36. PMID: 28720634; https://doi.org/10.3122/jabfm.2017.04.170121.
Nothelle SK, Sharma R, Oakes A, Jackson M, Segal JB. Factors associated with potentially inappropriate medication use in community-dwelling older adults in the United States: a systematic review. Int J Pharm Pract. 2019;27(5):408-23. PMID: 30964225; https://doi.org/10.1111/ijpp.12541.
Lebrão ML, Laurenti R. Saúde, bem-estar e envelhecimento: o estudo SABE no Município de São Paulo [Health, Well-Being and Aging: the SABE Study in São Paulo, Brazil]. Rev Bras Epidemiol. 2005;8(2):127-41. https://doi.org/10.1590/S1415-790X2005000200005.
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state” a practical method for grading the cognitive state of patients for the clinician. J Psychiat Res. 1975;12(3):189-98. PMID: 1202204; https://doi.org/10.1016/0022-3956(75)90026-6.
Bertolucci PHF, Brucki SMD, Campacci SR, Juliano Y. O Mini-Exame do Estado Mental em uma população geral: impacto da escolaridade [The Mini-Mental State Examination in an outpatient population: influence of literacy]. Arq Neuropsiquiatr. 1994;52(1):1-7.1994;52(1):1-7. https://doi.org/10.1590/s0004-282x1994000100001.
Brucki SM, Nitrini R, Caramelli P, Bertolucci PH, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil [Suggestions for utilization of the mini-mental state examination in Brazil]. Arq Neuropsiquiatr. 2003;61(3B):777-81. PMID: 14595482; https://doi.org/10.1590/s0004-282x2003000500014.
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged: the index of ADL: A standardized measure of biological and psychosocial function. JAMA. 1963;185:914-9. PMID: 14044222; https://doi.org/10.1001/jama.1963.03060120024016.
de Oliveira Duarte YA, Laranjeira de Andrade C, Lebrão ML. O Index de Katz na avaliação da funcionalidade dos idosos [Katz Index on elderly functionality evaluation]. Rev Esc Enferm USP. 2007;41(2):317-25. PMID: 17722401; https://doi.org/10.1590/s0080-62342007000200021.
Pfeffer RI, Kurosaki TT, Harrah CH, Chance JM, Filos S. Measurement of functional activities in older adults in the community. Journal of Gerontology. 1982;37(3):323-9. https://doi.org/10.1093/geronj/37.3.323.
Dutra MC, Dos Sabtos Ribeiro R, Sarah Brandão Pinheiro SB, de Melo GF, de Azevedo Carvalho G. Acurácia e confiabilidade do questionário de Pfeffer para a população idosa brasileira [Accuracy and reliability of the Pfeffer Questionnaire for the Brazilian elderly population]. Dement Neuropsychol. 2015;9(2):176-83. https://doi.org/10.1590/1980-57642015DN92000012.
Gomes MS, Amorim WW, Morais RS, et al. Polypharmacy in older patients at primary care units in Brazil. Int J Clin Pharm. 2019;41(2):516-24. PMID: 30680513; https://doi.org/10.1007/s11096-018-00780-5.
Nyborg G, Straand J, Brekke M. Inappropriate prescribing for the elderly--a modern epidemic? Eur J Clin Pharmacol. 2012;68(7):1085-94. PMID: 22349159; https://doi.org/10.1007/s00228-012-1223-8.
Vezmar Kovačević S, Simišić M, Stojkov Rudinski S, et al. Potentially inappropriate prescribing in older primary care patients. PLoS One. 2014;9(4):e95536. PMID: 24763332; https://doi.org/10.1371/journal.pone.0095536.
Bruin-Huisman L, Abu-Hanna A, Van Weert HCPM, Beers E. Potentially inappropriate prescribing to older patients in primary care in the Netherlands: a retrospective longitudinal study. Age Ageing. 2017;46(4):614-9. PMID: 28064167; https://doi.org/10.1093/ageing/afw243.
Nuñez-Montenegro A, Montiel-Luque A, Martin-Aurioles E, et al. Evaluation of inappropriate prescribing in patients older than 65 years in primary health care. J Clin Med. 2019;8(3):305. PMID: 30836699; https://doi.org/10.3390/jcm8030305.
Moriarty F, Bennett K, Cahir C, Fahey T. Evaluating the economic impact of potentially inappropriate prescribing in older people in Ireland using a Markov modelling approach. Value in Health. 2016;19(7):A402. https://doi.org/10.1016/j.jval.2016.09.319.
American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc. 2009;57(8):1331-46. PMID: 19573219; https://doi.org/10.1111/j.1532-5415.2009.02376.x.
