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Potentially inappropriate medication use in hospitalized elders
Michael B Rothberg1, Penelope S Pekow, Fengjuan Liu
1Division of General Medicine and Geriatrics, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts 01199, USA. Michael.Rothberg@bhs.org
Journal of Hospital Medicine
|April 29, 2008
Summary
Nearly half of older inpatients received potentially inappropriate medications (PIMs). Prescribing varied widely by patient, physician, and hospital factors, indicating a need to reduce non-patient-centered variations in care.
Area of Science:
- Geriatric Medicine
- Pharmacology
- Health Services Research
Background:
- Potentially harmful medication prescribing in hospitals is not well-documented.
- Understanding prescribing patterns is crucial for patient safety.
Purpose of the Study:
- To determine the rate of potentially inappropriate medication (PIM) prescribing in a large inpatient sample.
- To identify patient, physician, and hospital factors associated with PIM prescribing.
Main Methods:
- Retrospective cohort study of 384 US hospitals from September 2002 to June 2005.
- Analysis of nearly 500,000 patients aged 65 years and older with common medical diagnoses.
- Multivariable logistic regression used to identify factors associated with PIM prescribing based on a modified Beers list.
Main Results:
- 49% of patients received at least one PIM; 6% received three or more.
- PIM prescribing varied significantly by patient demographics, medical conditions (e.g., myocardial infarction, heart failure), insurance type, and age.
- Physician specialty and geographic region (e.g., South vs. Northeast) were associated with PIM use, with extreme variation observed between hospitals.
Conclusions:
- Significant variation exists in PIM prescribing among hospitals and physicians.
- Minimizing non-patient-centered variations in prescribing practices can potentially improve patient care.
- Further research is needed to address the factors contributing to this wide variation.
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