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High-risk prescribing in an Irish primary care population: trends and variation
Catherine J Byrne1, Caitriona Cahir1, Carmel Curran2
1Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
Insights
High-risk prescribing (HRP) in Ireland decreased from 2011-2015, but still affects many patients. Variations between general practitioners and pharmacies highlight opportunities to improve medication safety for older adults.
Area of Science:
- Health Sciences
- Pharmaceutical Sciences
- Gerontology
Background:
- High-risk prescribing (HRP) poses a significant threat to patient safety, particularly in community-dwelling older adults.
- Understanding the prevalence and contributing factors of HRP is crucial for developing targeted interventions.
Purpose of the Study:
- To investigate the prevalence of HRP in Ireland between 2011 and 2015 using validated indicators.
- To identify factors associated with HRP and analyze variations in HRP rates among general practitioners (GPs) and in prescription dispensing by pharmacies.
Main Methods:
- A repeated cross-sectional study utilizing a national pharmacy claims database.
- Consensus-validated prescribing indicators were applied to pharmacy claims data.
- Multilevel logistic regression models were employed to analyze factors associated with HRP and dispensing patterns.
Main Results:
- Significant reductions in HRP rates were observed from 2011 (21.9%) to 2015 (15.1%).
- Key HRP indicators in 2015 included NSAID use without gastroprotection in the elderly, concurrent warfarin and antiplatelet/antibiotic use, and high-dose digoxin prescriptions.
- HRP prevalence increased with age and the number of chronic medications. Significant variations in HRP rates were found between GPs and in dispensing practices between pharmacies, even after controlling for patient-level factors.
Conclusions:
- While HRP in Ireland has declined, certain prescribing practices remain a concern.
- The identified variations between GPs and pharmacies indicate potential for improving medication safety in community care, especially for vulnerable elderly populations.
Aims:
The aims of the present study were to examine the prevalence of high-risk prescribing (HRP) in community-dwelling adults in Ireland from 2011-2015 using consensus-validated indicators, factors associated with HRP, and the variation in HRP between general practitioners (GPs) and in the dispensing of high-risk prescriptions between pharmacies.
Methods:
A repeated cross-sectional national pharmacy claims database study was conducted. Prescribing indicators were based on those developed in formal consensus studies and applicable to pharmacy claims data. Multilevel logistic regression was used to examine factors associated with HRP and dispensing.
Results:
There were significant reductions in the rates of most indicators over time (P < 0.001). A total of 66 022 of 300 906 patients at risk in 2011 [21.9%, 95% confidence interval (CI) 21.8, 22.1%], and 42 109 of 278 469 in 2015 (15.1%, 95% CI 15.0, 15.3%), received ≥1 high-risk prescription (P < 0.001). In 2015, indicators with the highest rates of HRP were prescription of a nonsteroidal anti-inflammatory drug (NSAID) without gastroprotection in those ≥75 years (37.2% of those on NSAIDs), coprescription of warfarin and an antiplatelet agent or high-risk antibiotic (19.5% and 16.2% of those on warfarin, respectively) and prescription of digoxin ≥250 μg day-1 in those ≥65 years (14.0% of those on digoxin). Any HRP increased significantly with age and number of chronic medications (P < 0.001). a) After controlling for patient variables, the variation in the rate of HRP between GPs was significant (P < 0.05); and b) after controlling for patient variables and the prescribing GP, the variation in the rate of dispensing of high-risk prescriptions between pharmacies was significant (P < 0.05).
Conclusions:
HRP in Ireland has declined over time, although some indicators persist. The variation between GPs and pharmacies suggests the potential for improvement in safe medicines use in community care, particularly in vulnerable older populations.
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