Older people are more likely to have an inappropriate prescription after hospitalization

November 14, 2018

A new study has found that older patients who were hospitalised were 72% more likely to be given a potentially inappropriate prescription after their hospital admission, independent of other patient factors.

The study, conducted by the HRB Centre for Primary Care Research based in the Department of General Practice at RCSI (Royal College of Surgeons in Ireland), is published in the current edition of The BMJ.

RCSI researchers looked at data from general practice records of 38,229 patients (aged ≥65 years) in Ireland from 2012 to 2015. To determine if the prescriptions were potentially inappropriate, they assessed the records using 45 criteria from the Screening Tool for Older Persons' Prescription (STOPP) version 2.

Commenting on the findings, senior research fellow with the HRB Centre for Primary Care Research at RCSI Dr Frank Moriarty said: "Adults aged 65 years and older are a growing population and represent the largest consumers of prescribed medications. When caring for older patients in primary care, achieving the balance of maximising patients' benefits from medicines while minimising harms and cost can be challenging.

"Research to date has focused on patient and GP characteristics as risk factors for poor prescribing quality. Our study illustrates the need to consider and address potential adverse effects of hospitalisation on prescribing appropriate medication for older patients."

The study found that potentially inappropriate prescribing (PIP) is becoming increasingly prevalent in older people, and hospitalisation is independently associated with an increased risk of PIP. When compared to older people who had not been hospitalised in the past year, the probability of at least one PIP during a year increases by 49% for hospitalised patients after adjusting for other factors, such as the number of prescriptions and type of healthcare cover.

Dr Moriarty said: "Although we adjusted for a range of patient characteristics, there is potential for unmeasured confounding variables, as with any observational study, which may partly or fully explain the results.

"However, many of the common criteria in our study relate to inappropriate duration of use for medicines used for sleep, acid suppression, and anti-inflammatory effect. Documenting and clearly communicating the intended prescription duration or planned review date would ensure that other clinicians, such as GPs, would have complete information for reviewing and stopping such prescriptions. It is vital to identify optimal management strategies for older people to ensure the risk of inappropriate medications is minimised following their time in hospitals."
The research was conducted in collaboration with the Department of Statistics and Data Science, Complutense University of Madrid, with support from the Spanish Ministry of Economy, Industry and Competitiveness. The study was funded by the Health Research Board (HRB) in Ireland through the HRB Centre for Primary Care Research.

The full paper, titled "Prevalence of potentially inappropriate prescribing in older people in primary care and its association with hospital admission: a longitudinal study", features in this week's edition of The BMJ.

RCSI is ranked among the top 250 (top 2%) of universities worldwide in the Times Higher Education World University Rankings (2019) and its research is ranked first in Ireland for citations. It is an international not-for-profit health sciences institution, with its headquarters in Dublin, focused on education and research to drive improvements in human health worldwide. RCSI has been awarded Athena SWAN Bronze accreditation for positive gender practice in higher education.


Related Primary Care Articles from Brightsurf:

Six ways primary care "medical homes" are lowering health care spending
New analysis of 394 U.S. primary care practices identifies the aspects of care delivery that are associated with lower health care spending and lower utilization of emergency care and hospital admissions.

Continuity of English primary care has worsened with GP expansions
A new study published by the British Journal of General Practice has found that patients' abilities to see their preferred GP has fallen greater in English practices that have expanded, compared with those that stayed about the same size.

Primary care office-based vs telemedicine care visits during COVID-19 pandemic
This observational study quantified national changes in the volume, type and content of primary care delivered during the COVID-19 pandemic, especially with regard to office-based visits compared with telemedicine encounters.

Expenditures for primary care may affect how primary care is delivered
This study looks at trends in out-of-pocket and total visit expenditures for visits to primary care physicians.

Primary care clinicians drove increasing use of Medicare's chronic care management codes
To address the problem of care fragmentation for Medicare recipients with multiple chronic conditions, Medicare introduced Chronic Care Management (CCM) in 2015 to reimburse clinicians for care management and coordination.

Primary care at a crossroads: Experts call for change
Primary care providers have experienced a rise in responsibilities with little or no increase in the time they have to get it all done, or reduction in the number of patients assigned to them.

Primary care physicians during the COVID-19 epidemic
Scientists from the University of Geneva has analysed clinical data from more than 1,500 ambulatory patients tested for COVID-19.

The five phases of pandemic care for primary care
The authors present a roadmap for necessary primary care practice transformations to care for patients and communities during the COVID-19 pandemic.

Women almost twice as likely to choose primary care as men
Analysis of osteopathic medical school survey data reveals women are 1.75 times more likely to choose primary care than men, according to a study in The Journal of the American Osteopathic Association.

Spending on primary care vs. other US health care expenditures
National health care survey data were used to assess the amount of money spent on primary care relative to other areas of health care spending in the US from 2002 to 2016.

Read More: Primary Care News and Primary Care Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.
Can't connect to localhost. Errorcode: 1203