Article
Potential risks for patients by drug prescribing in primary care in the Federal State of Hessen
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Published: | November 12, 2007 |
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Context: Numerous studies suggest that number of drugs prescribed and age may be risk factors for potential harm from medication. Adverse drug reactions (ADRs) represent a challenging and expensive public health problem.
Aim of the study: The purpose of this study was to identify polypharmacy, inappropriate drug combinations, and drugs with high potential for causing ADRs in elderly patients at baseline, before an intervention to optimize prescribing patterns of primary care physicians participating in quality circles on rational prescribing in Hesse, Germany.
Design: The intervention group comprises of about 2,000 primary care physicians in more than 1,500 practices (general practitioners or primary care internists) who prescribe drugs for about 1.2 million patients. Although participation is voluntary physicians who signed general-practitioner-centered care should attend continuing medical education. Because during the whole study period physicians can continuously enter in the intervention (quality circles, data-based feedback) allocation to randomised groups was not possible. All prescribing data were provided from health funds.
Results: Before intervention (2005), in half of the practices more than 9% of the patients received more than 5 drugs per quarter and at the same time more than 1.4% of the patients were prescribed potentially interacting drug combinations. In half of the practices at least 27% of the elderly patients (>65 years) were maintained on >4 drugs with 7% receiving drugs described as inappropriate for elderly (Beers criteria).
Conclusion: This study revealed that before the intervention a substantial fraction of ambulatory patients was exposed to medication regimens with risks for ADRs and that there is a need for improvement. The impact of quality circles will be evaluated with follow-up data.