Related Experiment Videos
Potentially inappropriate prescribing in elderly veterans: are we using the wrong drug, wrong dose, or wrong
Mary Jo V Pugh1, B Graeme Fincke, Arlene S Bierman
1Veterans Evidence-based Research Dissemination and Implementation Center, Audie L. Murphy Division /South Texas Veterans Health Care System, San Antonio, Texas 78229, USA. pughm@uthscsa.edu
Journal of the American Geriatrics Society
|August 5, 2005
Summary
Inappropriate prescribing among older veterans decreased but remained high, particularly with pain relievers and psychiatric medications. Interventions targeting these drug classes are crucial for improving patient outcomes.
Area of Science:
- Geriatric pharmacology
- Health services research
- Medication safety
Background:
- Inappropriate prescribing in older adults is a significant public health concern.
- Established criteria, such as the Agency for Healthcare Research and Quality (AHRQ) Zhan criteria and Beers criteria, aim to guide appropriate medication use.
- Understanding the extent and characteristics of inappropriate prescribing is essential for developing targeted interventions.
Purpose of the Study:
- To quantify inappropriate prescribing in older veterans using AHRQ Zhan criteria and Beers criteria for dose-limitations.
- To describe the duration of inappropriate drug exposure.
- To identify patient characteristics associated with inappropriate prescribing.
Main Methods:
- Retrospective analysis of Veterans Health Administration (VA) administrative data for fiscal year 2000.
- Inclusion of veterans aged 65 and older with at least one VA outpatient visit.
- Identification of inappropriate prescribing based on expert-defined Zhan criteria and Beers dose-limitation criteria.
Main Results:
- Inappropriate prescribing decreased from 33% to 23% after adjustments for diagnoses, dose, and duration.
- Prolonged exposure to inappropriate medications was observed.
- Pain relievers, benzodiazepines, antidepressants, and musculoskeletal agents accounted for 61% of inappropriate prescriptions.
- White patients, those with psychiatric comorbidities, and those on polypharmacy were more likely to receive inappropriate drugs.
Conclusions:
- The AHRQ Zhan criteria alone did not fully explain inappropriate prescribing, highlighting issues with dose and duration.
- Targeted interventions for pain relievers, benzodiazepines, antidepressants, and musculoskeletal agents hold significant potential to reduce inappropriate prescribing.
- Reducing inappropriate prescribing can lead to improved patient outcomes in older adults.