Potentially inappropriate prescribing in elderly veterans: Are we using the wrong drug, wrong dose, or wrong duration?

Mary Jo V Pugh, B. Graeme Fincke, Arlene S. Bierman, Bei Hung Chang, Amy K. Rosen, Francesca E. Cunningham, Megan E. Amuan, Muriel L. Burk, Dan R. Berlowitz

Research output: Contribution to journalArticle

61 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)1282-1289
Number of pages8
JournalJournal of the American Geriatrics Society
Volume53
Issue number8
DOIs
StatePublished - Aug 2005
Externally publishedYes

Fingerprint

Inappropriate Prescribing
Veterans
Veterans Health
United States Department of Veterans Affairs
Pharmaceutical Preparations
Health Services Research
Benzodiazepines
Antidepressive Agents
Prescriptions
Outpatients
Pain
Psychiatry
Comorbidity
Databases

Keywords

  • Appropriateness
  • Geriatrics
  • Patient safety
  • Pharmacoepidemiology
  • Prescribing

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Pugh, M. J. V., Fincke, B. G., Bierman, A. S., Chang, B. H., Rosen, A. K., Cunningham, F. E., ... Berlowitz, D. R. (2005). Potentially inappropriate prescribing in elderly veterans: Are we using the wrong drug, wrong dose, or wrong duration? Journal of the American Geriatrics Society, 53(8), 1282-1289. https://doi.org/10.1111/j.1532-5415.2005.53402.x

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 journalArticle

Pugh, MJV, Fincke, BG, Bierman, AS, Chang, BH, Rosen, AK, Cunningham, FE, Amuan, ME, Burk, ML & Berlowitz, DR 2005, 'Potentially inappropriate prescribing in elderly veterans: Are we using the wrong drug, wrong dose, or wrong duration?', Journal of the American Geriatrics Society, vol. 53, no. 8, pp. 1282-1289. https://doi.org/10.1111/j.1532-5415.2005.53402.x
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. / Potentially inappropriate prescribing in elderly veterans : Are we using the wrong drug, wrong dose, or wrong duration?. In: Journal of the American Geriatrics Society. 2005 ; Vol. 53, No. 8. pp. 1282-1289.
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