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

Research Article

Behrooz Tavakoly¹  David Melzer²  Alessandro Ble²  Rachel E. Winder³  Jose M. Valderas⁴  William E. Henley⁵  Jane A. H. Masoli⁶  Suzanne H. Richards⁷  Heather E. Barry⁸  George A. Kuchel⁹ 

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

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

DOI  :  10.1186/s12877-015-0143-8

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

来源: Springer

【 摘 要 】

BackgroundHigh 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.MethodsThree 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.ResultsWhile 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.ConclusionsHigh 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】

CC BY   
© Ble et al. 2015