Abstract
Objective
The quality of medication use by the elderly is a major safety concern because of an increasing number of people in this segment of the population and the fact that they are major drug consumers. The objective of this study was to test whether administrative computerized pharmacy prescription data could be used to assess the prevalence of potentially inappropriate medication use by the elderly in Rijeka, Croatia, using two sets of explicit criteria data.
Methods
In 2002, the prevalence of potentially inappropriate medication use in the elderly aged 70 years or over was evaluated using Beers’ criteria. Inappropriate co-prescribing was evaluated using a list of eight potentially harmful drug combinations. Information on the use of drugs was collected from a computerized pharmacy record of all prescriptions dispensed in the “Jadran Pharmacies” in Rijeka.
Results
Five computerized pharmacies dispensed 306,000 (65% of all prescriptions in Rijeka); 78,000 were for those aged 70 years and over. Among these elderly, the prevalence of inappropriate choice of drugs was 2.2% and inadequate co-prescribing 1.9%. The most common inappropriate drug was a long-acting benzodiazepine, diazepam. Mostly used potentially harmful combinations were a non-steroidal anti-inflammatory drug (NSAID) co-prescribed with a diuretic, and two benzodiazepines co-prescribed.
Conclusion
We found that computerized pharmacy data can be used as a screening tool in efforts to improve the quality of drug prescribing in Rijeka. Explicit criteria for assessing inappropriate prescribing for the elderly can easily be applied to population based surveys. This study suggests a low rate of potentially inappropriate prescribing for the elderly in Rijeka.
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References
Bergman U, Herxheimer U (1993) Drug utilisation research in Europe. Lancet 342:167
Knight EL, Avorn J (2001) Quality indicators for appropriate medication use in vulnerble elders. Ann Intern Med 135:703–710
WHO (2002) Guidelines for ATC classification and DDD assignment. WHO Collaborating Centre for Drug Statistics Methodology, Oslo
Beers M (1997) Explicit criteria for determining potentially inappropriate medication use by the elderly: an update. Arch Intern Med 157:1531–1536
Strom BL (ed) (2000) Pharmacoepidemiology 3rd edn. John Wiley & Sons, Ltd, Chichester, New York
Aparasu RR, Mort JR (2000) Inappropriate prescribing for the elderly: Beers criteria based review. Ann Pharmcother 34:338–345
Laurier C, Moride Y, Kennedy WA (2002) Health survey data on potentially inappropriate geriatric drug use. Ann Pharmacother 36:404–409
Zhan C, Sangl J, Bierman AS, Miller MR, Friedman, Wickizer SW, Meyer GS (2001) Potentially inappropriate medication use in the community-dwelling elderly. Findings from the 1996 Medical Expenditure Panel Survey. JAMA 286:2823–2829
Straand J, Rokstad KS (1999) Elderly patients in general practice: diagnoses, drugs and inappropriate prescriptions. A report from the Møre & Romsdal Prescription Study. Fam Pract 16:380–388
Sjöqvist F (1997) A new classification system for drug interactions. Eur J Clin Pharmacol 52[Suppl]:A126
Page J, Henry D (2000) Consumption of NSAIDs and the development of congestive heart failure in elderly patients: an unrecognized public health problem. Arch Int Med 160:777–784
McLeod PJ, Huang AR, Tamblyn RM, Gayton DC (1997) Defining inappropriate practices in prescribing for elderly people: a national consensus panel. Can Med Assoc J 156:385–391
Svensk Läkemedelsstatistik 2000 (2000) Apoteket AB, Stockholm (Swedish Drug Statistics 2000, National Corporation of Swedish Pharmacies)
Thomson O’Brian MA, Oxman AD, Davis DA, Haynes RB, Freemantle N, Harvey EL (2001) Audit and feedback: effects on professional practice and health care outcomes (Cochrane Review). In: The Cochrane Library, Issue 4, Update Software, Oxford
Figueiras A, Sastre I, Gestal-Otero J (2001) Effectiveness of educational interventions on the improvement of drug prescription in primary care: a critical literature review. J Eval Clin Pract 7:223–241
Vlahović-Palčevski V, Wettermark B, Prpić I, Bergman U (2004) Attitudes to feedback with drug utilisation 90% (DU90%) profiles among prescribers in Rijeka, Croatia. Pharmacoepidemiol Drug Safety (in press)
Acknowledgements
We thank Silvana Jager, MSc Pharm, for providing anonymous prescription data. We acknowledge the Swedish Institute for a scholarship and Pharmacia Corp. for an unrestricted grant to Vera Vlahović-Palčevski.
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Vlahović-Palčevski, V., Bergman, U. Quality of prescribing for the elderly in Croatia—computerized pharmacy data can be used to screen for potentially inappropriate prescribing. Eur J Clin Pharmacol 60, 217–220 (2004). https://doi.org/10.1007/s00228-004-0747-y
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DOI: https://doi.org/10.1007/s00228-004-0747-y