Abstract
OBJECTIVES: To identify the extent of inappropriate prescribing using criteria for proper use developed by the Agency for Healthcare Research and Quality (AHRQ) and dose-limitation criteria defined by Beers, as well as to describe duration of use and patient characteristics associated with inappropriate prescribing for older people. DESIGN: Retrospective national Veterans Health Administration (VA) administrative database analysis. SETTING: VA outpatient facilities during fiscal year 2000 (FYOO). PARTICIPANTS: Veterans aged 65 and older having at least one VA outpatient visit in FYOO (N = 1,265,434). MEASUREMENTS: Operational definitions of appropriate use were developed based on recommendations of an expert panel convened by the AHRQ (Zhan criteria). Inppropriate use was identified based on these criteria and inappropriate use of drugs per Beers criteria for dose-limitations in older people. Furthermore, duration of use and patient characteristics associated with inappropriate use were described. RESULTS: After adjusting for diagnoses, dose, and duration, inappropriate prescribing decreased from 33% to 23%. Exposure to inappropriate drugs was prolonged. Pain relievers, benzodiazepines, antidepressants, and musculoskeletal agents constituted 61% of inappropriate prescribing. Whites, patients with psychiatric comorbidities, and patients receiving more medications were most likely to receive inappropriate drugs. Women were more likely to receive Zhan criteria drugs; men were more likely to receive dose-limited drugs CONCLUSION: For the most part, the Zhan criteria did not explain inappropriate prescribing, which includes problems related to dose and duration of prescriptions. Interventions targeted at prescriptions for pain relievers, benzodiazepines, antidepressants, and musculoskeletal agents may dramatically decrease inappropriate prescribing and improve patient outcomes.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1282-1289 |
| Number of pages | 8 |
| Journal | Journal of the American Geriatrics Society |
| Volume | 53 |
| Issue number | 8 |
| DOIs | |
| State | Published - Aug 2005 |
| Externally published | Yes |
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Keywords
- Appropriateness
- Geriatrics
- Patient safety
- Pharmacoepidemiology
- Prescribing
ASJC Scopus subject areas
- Geriatrics and Gerontology
Cite this
Potentially inappropriate prescribing in elderly veterans : Are we using the wrong drug, wrong dose, or wrong duration? / Pugh, Mary Jo V; Fincke, B. Graeme; Bierman, Arlene S.; Chang, Bei Hung; Rosen, Amy K.; Cunningham, Francesca E.; Amuan, Megan E.; Burk, Muriel L.; Berlowitz, Dan R.
In: Journal of the American Geriatrics Society, Vol. 53, No. 8, 08.2005, p. 1282-1289.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Potentially inappropriate prescribing in elderly veterans
T2 - Are we using the wrong drug, wrong dose, or wrong duration?
AU - Pugh, Mary Jo V
AU - Fincke, B. Graeme
AU - Bierman, Arlene S.
AU - Chang, Bei Hung
AU - Rosen, Amy K.
AU - Cunningham, Francesca E.
AU - Amuan, Megan E.
AU - Burk, Muriel L.
AU - Berlowitz, Dan R.
PY - 2005/8
Y1 - 2005/8
N2 - OBJECTIVES: To identify the extent of inappropriate prescribing using criteria for proper use developed by the Agency for Healthcare Research and Quality (AHRQ) and dose-limitation criteria defined by Beers, as well as to describe duration of use and patient characteristics associated with inappropriate prescribing for older people. DESIGN: Retrospective national Veterans Health Administration (VA) administrative database analysis. SETTING: VA outpatient facilities during fiscal year 2000 (FYOO). PARTICIPANTS: Veterans aged 65 and older having at least one VA outpatient visit in FYOO (N = 1,265,434). MEASUREMENTS: Operational definitions of appropriate use were developed based on recommendations of an expert panel convened by the AHRQ (Zhan criteria). Inppropriate use was identified based on these criteria and inappropriate use of drugs per Beers criteria for dose-limitations in older people. Furthermore, duration of use and patient characteristics associated with inappropriate use were described. RESULTS: After adjusting for diagnoses, dose, and duration, inappropriate prescribing decreased from 33% to 23%. Exposure to inappropriate drugs was prolonged. Pain relievers, benzodiazepines, antidepressants, and musculoskeletal agents constituted 61% of inappropriate prescribing. Whites, patients with psychiatric comorbidities, and patients receiving more medications were most likely to receive inappropriate drugs. Women were more likely to receive Zhan criteria drugs; men were more likely to receive dose-limited drugs CONCLUSION: For the most part, the Zhan criteria did not explain inappropriate prescribing, which includes problems related to dose and duration of prescriptions. Interventions targeted at prescriptions for pain relievers, benzodiazepines, antidepressants, and musculoskeletal agents may dramatically decrease inappropriate prescribing and improve patient outcomes.
AB - OBJECTIVES: To identify the extent of inappropriate prescribing using criteria for proper use developed by the Agency for Healthcare Research and Quality (AHRQ) and dose-limitation criteria defined by Beers, as well as to describe duration of use and patient characteristics associated with inappropriate prescribing for older people. DESIGN: Retrospective national Veterans Health Administration (VA) administrative database analysis. SETTING: VA outpatient facilities during fiscal year 2000 (FYOO). PARTICIPANTS: Veterans aged 65 and older having at least one VA outpatient visit in FYOO (N = 1,265,434). MEASUREMENTS: Operational definitions of appropriate use were developed based on recommendations of an expert panel convened by the AHRQ (Zhan criteria). Inppropriate use was identified based on these criteria and inappropriate use of drugs per Beers criteria for dose-limitations in older people. Furthermore, duration of use and patient characteristics associated with inappropriate use were described. RESULTS: After adjusting for diagnoses, dose, and duration, inappropriate prescribing decreased from 33% to 23%. Exposure to inappropriate drugs was prolonged. Pain relievers, benzodiazepines, antidepressants, and musculoskeletal agents constituted 61% of inappropriate prescribing. Whites, patients with psychiatric comorbidities, and patients receiving more medications were most likely to receive inappropriate drugs. Women were more likely to receive Zhan criteria drugs; men were more likely to receive dose-limited drugs CONCLUSION: For the most part, the Zhan criteria did not explain inappropriate prescribing, which includes problems related to dose and duration of prescriptions. Interventions targeted at prescriptions for pain relievers, benzodiazepines, antidepressants, and musculoskeletal agents may dramatically decrease inappropriate prescribing and improve patient outcomes.
KW - Appropriateness
KW - Geriatrics
KW - Patient safety
KW - Pharmacoepidemiology
KW - Prescribing
UR - http://www.scopus.com/inward/record.url?scp=25144437450&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=25144437450&partnerID=8YFLogxK
U2 - 10.1111/j.1532-5415.2005.53402.x
DO - 10.1111/j.1532-5415.2005.53402.x
M3 - Article
C2 - 16078952
AN - SCOPUS:25144437450
VL - 53
SP - 1282
EP - 1289
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
SN - 0002-8614
IS - 8
ER -