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Potentially Inappropriate Medication Use Among Elderly Home Care Patients in Europe
Daniela Fialová, PharmD;
Eva Topinková, MD, PhD;
Giovanni Gambassi, MD;
Harriet Finne-Soveri, MD, PhD;
Pálmi V. Jónsson, MD;
Iain Carpenter, MD, FRCP;
Marianne Schroll, DrScM;
Graziano Onder, MD, PhD;
Liv Wergeland Sørbye, RN;
Cordula Wagner, MD, PhD;
Jindra Reissigová, RNDr;
Roberto Bernabei, MD; for the AdHOC Project Research Group
JAMA. 2005;293:1348-1358.
Context Criteria for potentially inappropriate medication use among elderly patients have been used in the past decade in large US epidemiological surveys to identify populations at risk and specifically target risk-management strategies. In contrast, in Europe little information is available about potentially inappropriate medication use and is based on small studies with uncertain generalizability.
Objective To estimate the prevalence and associated factors of potentially inappropriate medication use among elderly home care patients in European countries.
Design, Setting, and Participants Retrospective cross-sectional study of 2707 elderly patients receiving home care (mean [SD] age, 82.2 [ 7.2] years) representatively enrolled in metropolitan areas of the Czech Republic, Denmark, Finland, Iceland, Italy, the Netherlands, Norway, and the United Kingdom. Patients were prospectively assessed between September 2001 and January 2002 using the Minimum Data Set in Home Care instrument.
Main Outcome Measures Prevalence of potentially inappropriate medication use was documented using all expert panels criteria for community-living elderly persons (Beers and McLeod). Patient-related characteristics independently associated with inappropriate medication use were identified with a multiple logistic regression model.
Results Combining all 3 sets of criteria, we found that 19.8% of patients in the total sample used at least 1 inappropriate medication; using older 1997 criteria it was 9.8% to 10.9%. Substantial differences were documented between Eastern Europe (41.1% in the Czech Republic) and Western Europe (mean 15.8%, ranging from 5.8% in Denmark to 26.5% in Italy). Potentially inappropriate medication use was associated with patient’s poor economic situation (adjusted relative risk [RR], 1.96; 95% confidence interval [CI], 1.58-2.36), polypharmacy (RR, 1.91; 95% CI, 1.62- 2.22), anxiolytic drug use (RR, 1.82; 95% CI, 1.51-2.15), and depression (RR, 1.29; 95% CI, 1.06-1.55). Negatively associated factors were age 85 years and older (RR, 0.78; 95% CI, 0.65-0.92) and living alone (RR, 0.76; 95% CI, 0.64-0.89). The odds of potentially inappropriate medication use significantly increased with the number of associated factors (P<.001).
Conclusions Substantial differences in potentially inappropriate medication use exist between European countries and might be a consequence of different regulatory measures, clinical practices, or inequalities in socioeconomic background. Since financial resources and selected patient-related characteristics are associated with such prescribing, specific educational strategies and regulations should reflect these factors to improve prescribing quality in elderly individuals in Europe.
Author Affiliations: Department of Geriatrics and Gerontology, 1st Medical Faculty, Charles University, Prague, Czech Republic (Drs Fialová and Topinková); Department of Social and Clinical Pharmacy, Faculty of Pharmacy, Hradec Králové, Czech Republic (Dr Fialová); Centro Medicina Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy (Drs Gambassi, Onder, and Bernabei); STAKES/CHESS (National Research and Development Center for Social Welfare and Health), Helsinki, Finland (Dr Finne-Soveri); Department of Geriatrics, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland (Dr Jónsson); Centre for Health Service Studies, The University of Kent & East Kent Hospitals NHS Trust, Canterbury, England (Dr Carpenter); Bispebjerg Hospital, Copenhagen, Denmark (Dr Schroll); The Decon College, Oslo, Norway (Ms Sørbye); NIVEL (Netherland Institute for Health Services Research), Utrecht, the Netherlands (Dr Wagner); and EuroMISE Centre, Institute of Computer Science AS CR, Prague, Czech Republic (Dr Reissigová).
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