Article
Inappropriate medication use in elderly multimorbid patients: disregard of Beers criteria and inconsistencies between prescription and drug intake in a cross-sectional study
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Authors
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C. Muth
- Institute for General Practice, Johann Wolfgang Goethe-University, Frankfurt / Main
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K. Zint
- Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg
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M. Beyer
- Institute for General Practice, Johann Wolfgang Goethe-University, Frankfurt / Main
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T. Rath
- Institute for General Practice, Johann Wolfgang Goethe-University, Frankfurt / Main
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K. Saal
- Institute for General Practice, Johann Wolfgang Goethe-University, Frankfurt / Main
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F. M. Gerlach
- Institute for General Practice, Johann Wolfgang Goethe-University, Frankfurt / Main
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W. E. Haefeli
- Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg
| Published: | November 12, 2007 |
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Outline
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Context: Inappropriate medication use is a major concern for patients’ safety, particularly for the elderly. Multimorbidity, polypharmacy, and prescriptions from different physicians combined with uncontrolled self-medication may exaggerate the risks for inadequate pharmacotherapy.
Aim of the study: To determine the prevalence of inappropriate medication use in elderly multimorbid patients in primary care according to preselected parameters including Beers criteria, to ascertain inconsistencies between prescription and drug intake.
Material and method: In a cross-sectional study in family practices we randomly selected 15 patients from the fifty most costly patients/practice, as documented in the practice software. Ten of these patients were included after giving written informed consent if they were ≥ 65 years old, had ≥ three chronic conditions, and long-term treatment with ≥ five drugs. Patients living in a nursing home or unable to answer a telephone interview were excluded.
Preliminary results: In the recruited 17 practices 20 general practitioners (GPs) (median age 51 yrs., range 42-57 yrs., 75% male) took part in the study. A total of 162 patients (50.6% male) with a median age of 73 (65-97) years were included. GPs documented a median of 11 (4-33) diagnoses, and eight (5-16) prescriptions of long-term medication per patient. A total of 153 patients or their caregivers were interviewed by telephone. They reported a median intake of 7 (2-20) long-term drugs. First analyses revealed the intake of inappropriate medication (e.g. doxepin, and amitriptyline). In about 30% the GPs’ prescriptions differed from patients’ reported medication intake (concerning active ingredient or dosage), and approximately 20% of the patients’ drugs were not mentioned or mentioned with a different dosage regimen in the GPs’ documentation.
Conclusion: Inappropriate medication according to the Beers criteria is still a challenge, and inconsistencies between medication prescription and intake seem to be a profound problem in primary care.
