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Prevalence of potentially inappropriate prescribing in older people in primary care and its association with hospital admission: longitudinal study

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4524 (Published 14 November 2018) Cite this as: BMJ 2018;363:k4524

Linked Editorial

Tackling potentially inappropriate prescribing

  1. Teresa Pérez, associate professor in statistics1 2,
  2. Frank Moriarty, senior research fellow2,
  3. Emma Wallace, senior lecturer in general practice2,
  4. Ronald McDowell, postdoctoral research fellow in biostatistics2 3,
  5. Patrick Redmond, systematic review project manager2 4,
  6. Tom Fahey, professor of general practice2
  1. 1Department of Statistics and Data Science, Complutense University of Madrid, Madrid, Spain
  2. 2HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
  3. 3Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen’s University Belfast, Belfast, UK
  4. 4Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
  1. Correspondence to: F Moriarty frankmoriarty{at}rcsi.ie (or @FrankMoriarty on Twitter)
  • Accepted 15 October 2018

Abstract

Objective To determine whether hospital admission is associated with potentially inappropriate prescribing among older primary care patients (aged ≥65 years) and whether such prescribing was more likely after hospital admission than before.

Design Longitudinal study of retrospectively extracted data from general practice records.

Setting 44 general practices in Ireland in 2012-15.

Participants Adults aged 65 years or over attending participating practices.

Exposure Admission to hospital (any hospital admission versus none, and post-admission versus pre-admission).

Main outcome measures Prevalence of potentially inappropriate prescribing assessed using 45 criteria from the Screening Tool for Older Persons’ Prescription (STOPP) version 2, analysed both as rate of distinct potentially inappropriate prescribing criteria met (stratified Cox regression) and binary presence of potentially inappropriate prescribing (logistic regression) and adjusted for patients’ characteristics. A sensitivity analysis used matching with propensity scores based on patients’ characteristics and diagnoses.

Results Overall 38 229 patients were included, and during 2012 the mean age was 76.8 (SD 8.2) years and 43% (13 212) were male. Each year, 10.4-15.0% (3015/29 077 in 2015 to 4537/30 231 in 2014) of patients had at least one hospital admission. The overall prevalence of potentially inappropriate prescribing ranged from 45.3% (13 940/30 789) of patients in 2012 to 51.0% (14 823/29 077) in 2015. Independently of age, sex, number of prescription items, comorbidity, and health cover, hospital admission was associated with a higher rate of distinct potentially inappropriate prescribing criteria met; the adjusted hazard ratio for hospital admission was 1.24 (95% confidence interval 1.20 to 1.28). Among participants who were admitted to hospital, the likelihood of potentially inappropriate prescribing after admission was higher than before admission, independent of patients’ characteristics; the adjusted odds ratio for after hospital admission was 1.72 (1.63 to 1.84). Analysis of propensity score matched pairs showed a slight reduction in the hazard ratio for hospital admission to 1.22 (1.18 to 1.25).

Conclusion Hospital admission was independently associated with potentially inappropriate prescribing. It is important to determine how hospital admission may affect appropriateness of prescribing for older people and how potential adverse consequences of admission can be minimised.

Footnotes

  • Contributors: All authors contributed to the conception and design of the study. RMcD, PR, and TF acquired the data. TP, FM, and RMcD analysed the data, and all authors interpreted the data. TP and FM drafted the manuscript, and all authors were involved in critical revision and approval of the final manuscript. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. TF is the guarantor.

  • Funding: The study was funded by the Health Research Board in Ireland through grant No HRC/2014/1 (TF) and the Spanish Ministry of Economy, Industry, and Competitiveness through grant MTM2016-75351-R (TP). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support for the study as detailed above; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: Ethical approval was obtained from the Irish College of General Practitioners.

  • Data sharing: No additional data available.

  • Transparency statement: The lead author affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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