%0 Journal Article %J BMJ Qual Saf %D 2011 %T Prevalence and outcomes of use of potentially inappropriate medicines in older people: cohort study stratified by residence in nursing home or in the community %A Barnett, K %A McCowan, Colin %A Evans, J M M %A Gillespie, N D %A Davey, P G %A Fahey, T %K Age Factors %K Aged %K Aged, 80 and over %K Cohort Studies %K Drug Utilization %K Female %K Humans %K Independent Living %K Male %K Medication Errors %K Nursing Homes %K Polypharmacy %K Prescription Drugs %K Prevalence %K Scotland %K Sex Factors %X OBJECTIVES: To compare the prevalence of use of potentially inappropriate medicines (PIMs) between older patients living in their own homes versus those living in nursing or residential homes, and to test the association between exposure to PIMs and mortality. DESIGN: Cohort study stratified by place of residence. SETTING: Tayside, Scotland. PARTICIPANTS: All people aged between 66 and 99 years who were resident or died in Tayside from 2005 to 2006. MAIN OUTCOME MEASURES: The exposure variable was PIM use as defined by Beers' Criteria. All cause mortality was the main outcome measure. RESULTS: 70,299 people were enrolled in the cohort of whom 96% were exposed to any medicine and 31% received a PIM. Place of residence was not associated with overall risk of receiving PIMs, adjusted OR 0.94, 95% CI 0.87 to 1.01. Exposure to five of the PIMs (including long-acting benzodiazepines) was significantly higher in nursing homes whereas exposure to five other PIMs (including amitriptyline and NSAIDs) was significantly lower. Exposure to PIMs was similar (20-46%) across all 71 general practices in Tayside and was not associated with increased risk of mortality after adjustment for age, gender and polypharmacy (adjusted OR 0.98, 95% CI 0.92 to 1.05). CONCLUSIONS: The authors question the validity of the full list of PIMs as an indicator of safety of medicines in older people because one-third of the population is exposed with little practice variation and no significant impact on mortality. Future studies should focus on management of a shorter list of genuinely high-risk medicines. %B BMJ Qual Saf %V 20 %P 275-81 %8 2011 Mar %G eng %U http://qualitysafety.bmj.com/content/20/3/275.full %N 3 %R 10.1136/bmjqs.2009.039818 %0 Journal Article %J Br J Clin Pharmacol %D 2010 %T Potentially inappropriate prescribing and cost outcomes for older people: a national population study %A Cahir, C %A Fahey, T %A Teeling, Mary %A Teljeur, C %A Feely, John %A Bennett, K %K Aged %K Aged, 80 and over %K Cohort Studies %K Costs and Cost Analysis %K Drug Prescriptions %K Female %K Humans %K Inappropriate Prescribing %K Ireland %K Male %K Medication Errors %K Polypharmacy %K Treatment Outcome %X AIMS: Optimization of drug prescribing in older populations is a priority due to the significant clinical and economic costs of drug-related illness. This study aimed to: (i) estimate the prevalence of potentially inappropriate prescribing (PIP) in a national Irish older population using European specific explicit prescribing criteria; (ii) investigate the association between PIP, number of drug classes, gender and age and; (iii) establish the total cost of PIP. METHODS: This was a retrospective national population study (n= 338 801) using the Health Service Executive Primary Care Reimbursement Service (HSE-PCRS) pharmacy claims database. The HSE-PCRS uses the WHO Anatomical Therapeutic Chemical (ATC) classification system and details of every drug dispensed and claimants' demographic data are available. Thirty PIP indicators (STOPP) were applied to prescription claims for those >or=70 years in Ireland in 2007. STOPP is a physiological system based screening tool of older persons' potentially inappropriate prescriptions assessing drug-drug and drug-disease interactions, dose and duration. RESULTS: In our study population PIP prevalence was 36% (121 454 claimants). The main contributors to this were: 56 560 (17%) prescribed proton pump inhibitors at maximum therapeutic dose for >8 weeks, 29 691 (9%) prescribed non-steroidal anti-inflammatories for >3 months, 17 676 (5%) prescribed long-acting benzodiazepines for >1 month and 16 201 (5%) prescribed duplicate drugs. The main determinant of PIP was polypharmacy. The likelihood of PIP increased with a significant linear and quadratic trend (P < 0.0001) with the number of drug classes.The maximum net ingredient cost of PIP was estimated to be euro38 664 640. Total PIP expenditure was estimated to be euro45 631 319, 9% of the overall expenditure on pharmaceuticals in those >or=70 years in 2007. CONCLUSIONS: The findings identify a high prevalence of PIP in Ireland with significant cost consequences. %B Br J Clin Pharmacol %V 69 %P 543-52 %8 2010 May %G eng %U http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2125.2010.03628.x/abstract %N 5 %R 10.1111/j.1365-2125.2010.03628.x %0 Journal Article %J British Journal of Clinical Pharmacology %D 2014 %T Going beyond the numbers – a call to redefine polypharmacy %A Hughes, CM %A Cooper, J %A Ryan, C %K Polypharmacy %B British Journal of Clinical Pharmacology %V 77 %8 05/2014 %G eng %U http://onlinelibrary.wiley.com/doi/10.1111/bcp.12284/pdf %N 6 %9 Published Article Journal %& 915-916 %R 10.1111/bcp.12284 %0 Journal Article %J Clin Geriatr Med %D 2012 %T Electronic prescribing and other forms of technology to reduce inappropriate medication use and polypharmacy in older people: a review of current evidence %A Clyne, B %A Bradley, MC %A Hughes, CM %A Fahey, T %A Lapane, Kate L %K Aged %K Aged, 80 and over %K Clinical Pharmacy Information Systems %K Decision Support Systems, Clinical %K Drug Prescriptions %K Drug Utilization Review %K Electronic Prescribing %K Evidence-Based Medicine %K Female %K Humans %K Inappropriate Prescribing %K Male %K Medication Errors %K Physician's Practice Patterns %K Polypharmacy %K Randomized Controlled Trials as Topic %X This review provided an overview of the current evidence in relation to the use of e-prescribing and other forms of technology, such as CDSS, to reduce inappropriate prescribing in older people. The evidence indicates that various types of e-prescribing and CDSS interventions have the potential to reduce inappropriate prescribing and polypharmacy in older people, but the magnitude of their effect varies according to study design and setting. There was significant heterogeneity in the studies reported in terms of study designs, intervention design, patient settings, and outcome measures with patient outcomes seldom reported. Widespread diffusion of these interventions has not occurred in any of the health care settings examined. Overall, health care providers report being satisfied with e-prescribing systems and see the systems as having a positive impact on the safety of their prescribing practices, yet the problem of overriding or ignoring alerts persists. The problem of large numbers of inaccurate and insignificant alerts and this issue, along with the other barriers that have been identified, warrant further investigation. %B Clin Geriatr Med %V 28 %P 301-22 %8 2012 May %G eng %U http://www.sciencedirect.com/science/article/pii/S0749069012000109 %N 2 %R 10.1016/j.cger.2012.01.009 %0 Journal Article %J BMC Health Services Research %D 2014 %T The development of the PROMPT (PRescribing Optimally in Middle-aged People’s Treatments) criteria %A Cooper, J %A Ryan, C %A Smith, SM %A Wallace, E %A Bennett, K %A Cahir, C %A Williams, David %A Teeling, Mary %A Hughes, CM %A PROMPT Steering Group %K Delphi technique %K Explicit criteria %K Middle-age %K multimorbidity %K Polypharmacy %K potentially inappropriate prescribing %X Abstract Background Whilst multimorbidity is more prevalent with increasing age, approximately 30% of middle-aged adults (45–64 years) are also affected. Several prescribing criteria have been developed to optimise medication use in older people (≥65 years) with little focus on potentially inappropriate prescribing (PIP) in middle-aged adults. We have developed a set of explicit prescribing criteria called PROMPT (PRescribing Optimally in Middle-aged People’s Treatments) which may be applied to prescribing datasets to determine the prevalence of PIP in this age-group. Methods A literature search was conducted to identify published prescribing criteria for all age groups, with the Project Steering Group (convened for this study) adding further criteria for consideration, all of which were reviewed for relevance to middle-aged adults. These criteria underwent a two-round Delphi process, using an expert panel consisting of general practitioners, pharmacists and clinical pharmacologists from the United Kingdom and Republic of Ireland. Using web-based questionnaires, 17 panellists were asked to indicate their level of agreement with each criterion via a 5-point Likert scale (1 = Strongly Disagree, 5 = Strongly Agree) to assess the applicability to middle-aged adults in the absence of clinical information. Criteria were accepted/rejected/revised dependent on the panel’s level of agreement using the median response/interquartile range and additional comments. Results Thirty-four criteria were rated in the first round of this exercise and consensus was achieved on 17 criteria which were accepted into the PROMPT criteria. Consensus was not reached on the remaining 17, and six criteria were removed following a review of the additional comments. The second round of this exercise focused on the remaining 11 criteria, some of which were revised following the first exercise. Five criteria were accepted from the second round, providing a final list of 22 criteria [gastro-intestinal system (n = 3), cardiovascular system (n = 4), respiratory system (n = 4), central nervous system (n = 6), infections (n = 1), endocrine system (n = 1), musculoskeletal system (n = 2), duplicates (n = 1)]. Conclusions PROMPT is the first set of prescribing criteria developed for use in middle-aged adults. The utility of these criteria will be tested in future studies using prescribing datasets. Keywords: Potentially inappropriate prescribing; Explicit criteria; Delphi technique; Middle-age; Polypharmacy; Multimorbidity %B BMC Health Services Research %V 14 %8 11/2014 %G eng %U http://www.biomedcentral.com/1472-6963/14/484 %9 Published Article Journal %R 10.1186/s12913-014-0484-6