Prevalence of potentially inappropriate prescribing in a subpopulation of older European clinical trial participants: a cross-sectional study
Objectives To estimate and compare the prevalence and type of potentially inappropriate prescribing (PIP) and potential prescribing omissions (PPOs) among community-dwelling older adults (≥65 years) enrolled to a clinical trial in three European countries.Design A secondary analysis of the Thyroid H...
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BMJ Publishing Group
2018-03-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/8/3/e019003.full |
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| author | Manuel R Blum Patricia M Kearney Rose Galvin Christine Baumgartner Anette Van Dorland Stephen Byrne Nicolas Rodondi Simon P Mooijaart Carol Sinnott Rosalinde K E Poortvliet Jacobijn Gussekloo David O Riordan Carole Elodie Aubert Kieran A Walsh Robert S Du Puy J Wouter Jukema Vera McCarthy Elaine K Walsh Tinh-Hai Collet Olaf M Dekkers |
| author_facet | Manuel R Blum Patricia M Kearney Rose Galvin Christine Baumgartner Anette Van Dorland Stephen Byrne Nicolas Rodondi Simon P Mooijaart Carol Sinnott Rosalinde K E Poortvliet Jacobijn Gussekloo David O Riordan Carole Elodie Aubert Kieran A Walsh Robert S Du Puy J Wouter Jukema Vera McCarthy Elaine K Walsh Tinh-Hai Collet Olaf M Dekkers |
| author_sort | Manuel R Blum |
| collection | DOAJ |
| description | Objectives To estimate and compare the prevalence and type of potentially inappropriate prescribing (PIP) and potential prescribing omissions (PPOs) among community-dwelling older adults (≥65 years) enrolled to a clinical trial in three European countries.Design A secondary analysis of the Thyroid Hormone Replacement for Subclinical Hypothyroidism Trial dataset.Participants A subset of 48/80 PIP and 22/34 PPOs indicators from the Screening Tool of Older Persons Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) V2 criteria were applied to prescribed medication data for 532/737 trial participants in Ireland, Switzerland and the Netherlands.Results The overall prevalence of PIP was lower in the Irish participants (8.7%) compared with the Swiss (16.7%) and Dutch (12.5%) participants (P=0.15) and was not statistically significant. The overall prevalence of PPOs was approximately one-quarter in the Swiss (25.3%) and Dutch (24%) participants and lower in the Irish (14%) participants (P=0.04) and the difference was statistically significant. The hypnotic Z-drugs were the most frequent PIP in Irish participants, (3.5%, n=4), while it was non-steroidal anti-inflammatory drug and oral anticoagulant combination, sulfonylureas with a long duration of action, and benzodiazepines (all 4.3%, n=7) in Swiss, and benzodiazepines (7.1%, n=18) in Dutch participants. The most frequent PPOs in Irish participants were vitamin D and calcium in osteoporosis (3.5%, n=4). In the Swiss and Dutch participants, they were bone antiresorptive/anabolic therapy in osteoporosis (9.9%, n=16, 8.6%, n=22) respectively. The odds of any PIP after adjusting for age, sex, multimorbidity and polypharmacy were (adjusted OR (aOR)) 3.04 (95% CI 1.33 to 6.95, P<0.01) for Swiss participants and aOR 1.74 (95% CI 0.79 to 3.85, P=0.17) for Dutch participants compared with Irish participants. The odds of any PPOs were aOR 2.48 (95% CI 1.27 to 4.85, P<0.01) for Swiss participants and aOR 2.10 (95% CI 1.11 to 3.96, P=0.02) for Dutch participants compared with Irish participants.Conclusions This study has estimated and compared the prevalence and type of PIP and PPOs among this cohort of community-dwelling older people. It demonstrated a significant difference in the prevalence of PPOs between the three populations. Further research is urgently needed into the impact of system level factors as this has important implications for patient safety, healthcare provision and economic costs. |
| format | Article |
| id | doaj-art-8d67c1ccef75450095ad439b179697ce |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2018-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-8d67c1ccef75450095ad439b179697ce2025-02-01T22:55:09ZengBMJ Publishing GroupBMJ Open2044-60552018-03-018310.1136/bmjopen-2017-019003Prevalence of potentially inappropriate prescribing in a subpopulation of older European clinical trial participants: a cross-sectional studyManuel R Blum0Patricia M Kearney1Rose Galvin2Christine Baumgartner3Anette Van Dorland4Stephen Byrne5Nicolas Rodondi6Simon P Mooijaart7Carol Sinnott8Rosalinde K E Poortvliet9Jacobijn Gussekloo10David O Riordan11Carole Elodie Aubert12Kieran A Walsh13Robert S Du Puy14J Wouter Jukema15Vera McCarthy16Elaine K Walsh17Tinh-Hai Collet18Olaf M Dekkers19Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandSchool of Public Health, University College Cork, Cork, IrelandSchool of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland1 Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland2 Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandprofessorInstitute of Primary Health Care (BIHAM), University of Bern, Bern, SwitzerlandDepartment of Internal Medicine, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands8 THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, United KingdomDepartment of Public Health and Primary Care, Leiden University Medical Center, Leiden, NetherlandsDepartment of Public Health and Primary Care, Leiden University Medical Center, Leiden, South-Holland, Netherlands1 Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Republic of IrelandInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland4 School of Public Health, University College Cork, Cork, Republic of IrelandDepartment of Public Health and Primary Care, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands10 Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands13 School of Nursing and Midwifery, University College Cork, Cork, Republic of Ireland14 School of Medicine, Department of General Practice, University College Cork, Cork, Republic of IrelandService of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital and University of Lausanne, Lausanne, SwitzerlandDepartment of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The NetherlandsObjectives To estimate and compare the prevalence and type of potentially inappropriate prescribing (PIP) and potential prescribing omissions (PPOs) among community-dwelling older adults (≥65 years) enrolled to a clinical trial in three European countries.Design A secondary analysis of the Thyroid Hormone Replacement for Subclinical Hypothyroidism Trial dataset.Participants A subset of 48/80 PIP and 22/34 PPOs indicators from the Screening Tool of Older Persons Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) V2 criteria were applied to prescribed medication data for 532/737 trial participants in Ireland, Switzerland and the Netherlands.Results The overall prevalence of PIP was lower in the Irish participants (8.7%) compared with the Swiss (16.7%) and Dutch (12.5%) participants (P=0.15) and was not statistically significant. The overall prevalence of PPOs was approximately one-quarter in the Swiss (25.3%) and Dutch (24%) participants and lower in the Irish (14%) participants (P=0.04) and the difference was statistically significant. The hypnotic Z-drugs were the most frequent PIP in Irish participants, (3.5%, n=4), while it was non-steroidal anti-inflammatory drug and oral anticoagulant combination, sulfonylureas with a long duration of action, and benzodiazepines (all 4.3%, n=7) in Swiss, and benzodiazepines (7.1%, n=18) in Dutch participants. The most frequent PPOs in Irish participants were vitamin D and calcium in osteoporosis (3.5%, n=4). In the Swiss and Dutch participants, they were bone antiresorptive/anabolic therapy in osteoporosis (9.9%, n=16, 8.6%, n=22) respectively. The odds of any PIP after adjusting for age, sex, multimorbidity and polypharmacy were (adjusted OR (aOR)) 3.04 (95% CI 1.33 to 6.95, P<0.01) for Swiss participants and aOR 1.74 (95% CI 0.79 to 3.85, P=0.17) for Dutch participants compared with Irish participants. The odds of any PPOs were aOR 2.48 (95% CI 1.27 to 4.85, P<0.01) for Swiss participants and aOR 2.10 (95% CI 1.11 to 3.96, P=0.02) for Dutch participants compared with Irish participants.Conclusions This study has estimated and compared the prevalence and type of PIP and PPOs among this cohort of community-dwelling older people. It demonstrated a significant difference in the prevalence of PPOs between the three populations. Further research is urgently needed into the impact of system level factors as this has important implications for patient safety, healthcare provision and economic costs.https://bmjopen.bmj.com/content/8/3/e019003.full |
| spellingShingle | Manuel R Blum Patricia M Kearney Rose Galvin Christine Baumgartner Anette Van Dorland Stephen Byrne Nicolas Rodondi Simon P Mooijaart Carol Sinnott Rosalinde K E Poortvliet Jacobijn Gussekloo David O Riordan Carole Elodie Aubert Kieran A Walsh Robert S Du Puy J Wouter Jukema Vera McCarthy Elaine K Walsh Tinh-Hai Collet Olaf M Dekkers Prevalence of potentially inappropriate prescribing in a subpopulation of older European clinical trial participants: a cross-sectional study BMJ Open |
| title | Prevalence of potentially inappropriate prescribing in a subpopulation of older European clinical trial participants: a cross-sectional study |
| title_full | Prevalence of potentially inappropriate prescribing in a subpopulation of older European clinical trial participants: a cross-sectional study |
| title_fullStr | Prevalence of potentially inappropriate prescribing in a subpopulation of older European clinical trial participants: a cross-sectional study |
| title_full_unstemmed | Prevalence of potentially inappropriate prescribing in a subpopulation of older European clinical trial participants: a cross-sectional study |
| title_short | Prevalence of potentially inappropriate prescribing in a subpopulation of older European clinical trial participants: a cross-sectional study |
| title_sort | prevalence of potentially inappropriate prescribing in a subpopulation of older european clinical trial participants a cross sectional study |
| url | https://bmjopen.bmj.com/content/8/3/e019003.full |
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