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Potentially Inappropriate Medication Dispensing in Outpatients: Comparison of Different Measurement Approaches.
Yves Eggli1, Patricia Halfon1, Minette-Joëlle Zeukeng2
1Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
Risk Management and Healthcare Policy
|November 29, 2023
Summary
Potentially inappropriate medication (PIM) prescribing is common in Switzerland, particularly sleeping pills and anxiolytics. Interventions targeting physicians with high PIM prescription rates are needed.
Area of Science:
- Pharmacovigilance
- Health Services Research
- Geriatric Medicine
Background:
- Potentially inappropriate medications (PIMs) pose risks to patient safety, especially in older adults.
- Routinely collected data offers a valuable resource for monitoring PIM prescribing patterns.
- Identifying and reducing PIM use is crucial for improving healthcare quality and patient outcomes.
Purpose of the Study:
- To compare different methods for measuring PIMs using routinely collected prescription data.
- To determine the rate and prevalence of PIM dispensing in Switzerland.
- To identify specific problematic prescribing practices and drug classes associated with PIMs.
Main Methods:
- Analysis of prescription data from approximately 90,000 individuals aged 17+ in a Swiss health maintenance organization (2019-2020).
- Comparison of PIM counts using established criteria (Beers, Priscus, Laroche, NORGEP, Prescrire) and a novel Swiss-context composite indicator.
- Stratification of PIM analysis by physician, including prescription initiation and cessation, and by age group.
Main Results:
- Each PIM measurement approach had unique strengths and weaknesses, supporting the development of a composite indicator.
- High rates of PIM prescribing were observed for sleeping pills, anxiolytics, and NSAIDs, even for chronic use.
- A composite indicator revealed that 27% of individuals over 64 received at least one PIM in 2020, with significant prescribing variations among physicians.
Conclusions:
- PIM prescribing is highly prevalent in Switzerland, driven by specific drug categories like sleeping pills and anxiolytics.
- Substantial physician-level variations in PIM prescribing necessitate targeted interventions for high-prescribing physicians.
- The findings highlight the need for improved PIM monitoring and targeted interventions to enhance medication safety in Switzerland.
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