Any versus long-term prescribing of high risk medications in older people using 2012 Beers Criteria: results from three cross-sectional samples of primary care records for 2003/4, 2007/8 and 2011/12

BMC Geriatrics

Suzanne H. Richards¹  David Melzer⁴  Jose M. Valderas⁷  George A. Kuchel⁶  William E. Henley³  Behrooz Tavakoly⁸  Rachel E. Winder²  Heather E. Barry⁹  Jane A. H. Masoli⁵  Alessandro Ble⁴ 

[1] Primary Care Research Group, Institute of Health Research, University of Exeter Medical School, Smeall Building, St Luke’s Campus, Exeter EX1 2LU, UK;Epidemiology and Public Health, Institute of Biomedical and Clinical Science, University of Exeter Medical School, Smeall Building, St Luke’s Campus, Exeter EX1 2LU, UK;Health Statistics, Institute of Health Research, University of Exeter Medical School, College House, St Luke’s Campus, Exeter EX1 2LU, UK;National Institute for Health Research (NIHR)‘School for Public Health Research, ᅟ, UK;Healthcare for Older People, Royal Devon and Exeter NHS Foundation Trust, Barrack Rd, Exeter EX2 5DW, UK;UConn Center on Aging, University of Connecticut Health Center, 263 Farmington Avenue, Farmington 06030-5215, CT, USA;Health Services & Policy Research, Institute of Health Research, University of Exeter Medical School, Smeall Building, St Luke’s Campus, Exeter EX1 2LU, UK;Epidemiology and Public Health, Institute of Biomedical and Clinical Science, University of Exeter Medical School, Barrack Road, Exeter EX2 5DW, UK;Primary Care, Institute of Health Research, University of Exeter Medical School, Smeall Building, St Luke’s Campus, Exeter EX1 2LU, UK

关键词: Family medicine;    Beers criteria;    Observational study;    Electronic medical records;    General practice;    Potentially inappropriate prescribing;    High risky medications;    Older people;    Polypharmacy;   

Others  :  1231045
DOI  :  10.1186/s12877-015-0143-8

 received in 2015-04-13, accepted in 2015-10-30,  发布年份 2015

【 摘 要 】

Background

High risk medications are commonly prescribed to older US patients. Currently, less is known about high risk medication prescribing in other Western Countries, including the UK. We measured trends and correlates of high risk medication prescribing in a subset of the older UK population (community/institutionalized) to inform harm minimization efforts.

Methods

Three cross-sectional samples from primary care electronic clinical records (UK Clinical Practice Research Datalink, CPRD) in fiscal years 2003/04, 2007/08 and 2011/12 were taken. This yielded a sample of 13,900 people aged 65 years or over from 504 UK general practices. High risk medications were defined by 2012 Beers Criteria adapted for the UK. Using descriptive statistical methods and regression modelling, prevalence of ‘any’ (drugs prescribed at least once per year) and ‘long-term’ (drugs prescribed all quarters of year) high risk medication prescribing and correlates were determined.

Results

While polypharmacy rates have risen sharply, high risk medication prevalence has remained stable across a decade. A third of older (65+) people are exposed to high risk medications, but only half of the total prevalence was long-term (any = 38.4 % [95 % CI: 36.3, 40.5]; long-term = 17.4 % [15.9, 19.9] in 2011/12). Long-term but not any high risk medication exposure was associated with older ages (85 years or over). Women and people with higher polypharmacy burden were at greater risk of exposure; lower socio-economic status was not associated. Ten drugs/drug classes accounted for most of high risk medication prescribing in 2011/12.

Conclusions

High risk medication prescribing has not increased over time against a background of increasing polypharmacy in the UK. Half of patients receiving high risk medications do so for less than a year. Reducing or optimising the use of a limited number of drugs could dramatically reduce high risk medications in older people. Further research is needed to investigate why the oldest old and women are at greater risk. Interventions to reduce high risk medications may need to target shorter and long-term use separately.

【 授权许可】

   
2015 Ble et al.

【 图 表 】

Fig. 1.

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