Inappropriateness of medication prescriptions to elderly patients in the primary care setting: a systematic review.

<h4>Background</h4>Inappropriate medication prescription is a common cause of preventable adverse drug events among elderly persons in the primary care setting.<h4>Objective</h4>The aim of this systematic review is to quantify the extent of inappropriate prescription to elder...

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Autores principales: Dedan Opondo, Saied Eslami, Stefan Visscher, Sophia E de Rooij, Robert Verheij, Joke C Korevaar, Ameen Abu-Hanna
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Publicado: Public Library of Science (PLoS) 2012
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spelling oai:doaj.org-article:9acd9bbf1fff426d972c2762051663932021-11-18T07:07:59ZInappropriateness of medication prescriptions to elderly patients in the primary care setting: a systematic review.1932-620310.1371/journal.pone.0043617https://doaj.org/article/9acd9bbf1fff426d972c2762051663932012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22928004/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Inappropriate medication prescription is a common cause of preventable adverse drug events among elderly persons in the primary care setting.<h4>Objective</h4>The aim of this systematic review is to quantify the extent of inappropriate prescription to elderly persons in the primary care setting.<h4>Methods</h4>We systematically searched Ovid-Medline and Ovid-EMBASE from 1950 and 1980 respectively to March 2012. Two independent reviewers screened and selected primary studies published in English that measured (in)appropriate medication prescription among elderly persons (>65 years) in the primary care setting. We extracted data sources, instruments for assessing medication prescription appropriateness, and the rate of inappropriate medication prescriptions. We grouped the reported individual medications according to the Anatomical Therapeutic and Chemical (ATC) classification and compared the median rate of inappropriate medication prescription and its range within each therapeutic class.<h4>Results</h4>We included 19 studies, 14 of which used the Beers criteria as the instrument for assessing appropriateness of prescriptions. The median rate of inappropriate medication prescriptions (IMP) was 20.5% [IQR 18.1 to 25.6%.]. Medications with largest median rate of inappropriate medication prescriptions were propoxyphene 4.52 (0.10-23.30)%, doxazosin 3.96 (0.32 15.70)%, diphenhydramine 3.30 (0.02-4.40)% and amitriptiline 3.20 (0.05-20.5)% in a decreasing order of IMP rate. Available studies described unequal sets of medications and different measurement tools to estimate the overall prevalence of inappropriate prescription.<h4>Conclusions</h4>Approximately one in five prescriptions to elderly persons in primary care is inappropropriate despite the attention that has been directed to quality of prescription. Diphenhydramine and amitriptiline are the most common inappropriately prescribed medications with high risk adverse events while propoxyphene and doxazoxin are the most commonly prescribed medications with low risk adverse events. These medications are good candidates for being targeted for improvement e.g. by computerized clinical decision support.Dedan OpondoSaied EslamiStefan VisscherSophia E de RooijRobert VerheijJoke C KorevaarAmeen Abu-HannaPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 8, p e43617 (2012)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Dedan Opondo
Saied Eslami
Stefan Visscher
Sophia E de Rooij
Robert Verheij
Joke C Korevaar
Ameen Abu-Hanna
Inappropriateness of medication prescriptions to elderly patients in the primary care setting: a systematic review.
description <h4>Background</h4>Inappropriate medication prescription is a common cause of preventable adverse drug events among elderly persons in the primary care setting.<h4>Objective</h4>The aim of this systematic review is to quantify the extent of inappropriate prescription to elderly persons in the primary care setting.<h4>Methods</h4>We systematically searched Ovid-Medline and Ovid-EMBASE from 1950 and 1980 respectively to March 2012. Two independent reviewers screened and selected primary studies published in English that measured (in)appropriate medication prescription among elderly persons (>65 years) in the primary care setting. We extracted data sources, instruments for assessing medication prescription appropriateness, and the rate of inappropriate medication prescriptions. We grouped the reported individual medications according to the Anatomical Therapeutic and Chemical (ATC) classification and compared the median rate of inappropriate medication prescription and its range within each therapeutic class.<h4>Results</h4>We included 19 studies, 14 of which used the Beers criteria as the instrument for assessing appropriateness of prescriptions. The median rate of inappropriate medication prescriptions (IMP) was 20.5% [IQR 18.1 to 25.6%.]. Medications with largest median rate of inappropriate medication prescriptions were propoxyphene 4.52 (0.10-23.30)%, doxazosin 3.96 (0.32 15.70)%, diphenhydramine 3.30 (0.02-4.40)% and amitriptiline 3.20 (0.05-20.5)% in a decreasing order of IMP rate. Available studies described unequal sets of medications and different measurement tools to estimate the overall prevalence of inappropriate prescription.<h4>Conclusions</h4>Approximately one in five prescriptions to elderly persons in primary care is inappropropriate despite the attention that has been directed to quality of prescription. Diphenhydramine and amitriptiline are the most common inappropriately prescribed medications with high risk adverse events while propoxyphene and doxazoxin are the most commonly prescribed medications with low risk adverse events. These medications are good candidates for being targeted for improvement e.g. by computerized clinical decision support.
format article
author Dedan Opondo
Saied Eslami
Stefan Visscher
Sophia E de Rooij
Robert Verheij
Joke C Korevaar
Ameen Abu-Hanna
author_facet Dedan Opondo
Saied Eslami
Stefan Visscher
Sophia E de Rooij
Robert Verheij
Joke C Korevaar
Ameen Abu-Hanna
author_sort Dedan Opondo
title Inappropriateness of medication prescriptions to elderly patients in the primary care setting: a systematic review.
title_short Inappropriateness of medication prescriptions to elderly patients in the primary care setting: a systematic review.
title_full Inappropriateness of medication prescriptions to elderly patients in the primary care setting: a systematic review.
title_fullStr Inappropriateness of medication prescriptions to elderly patients in the primary care setting: a systematic review.
title_full_unstemmed Inappropriateness of medication prescriptions to elderly patients in the primary care setting: a systematic review.
title_sort inappropriateness of medication prescriptions to elderly patients in the primary care setting: a systematic review.
publisher Public Library of Science (PLoS)
publishDate 2012
url https://doaj.org/article/9acd9bbf1fff426d972c276205166393
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