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About one in five elderly patients receives a prescription for a drug that is inappropriate for them to use, with two anti-depressants topping the list of inappropriate medications, according to a study reported in the August 9/23 issue of the Archives of Internal Medicine.
Lesley H. Curtis, Ph.D., of Duke University Medical Center, and his colleagues examined the extent of potentially inappropriate medication prescribing for elderly patients not in the hospital.
Inappropriate medications were identified according to criteria set by an expert panel of physicians and pharmacologists that make up the Beers revised list of drugs for drugs to be avoided in the elderly.
The researchers studied the outpatient claims database of a large national pharmaceutical benefit company that included 765,423 patients aged 65 or older who filled one or more prescription drug claims during 1999.
The researchers found that 162,370 or 21 percent of the patients filled a prescription for one or more medications that should be avoided in elderly patients or which are inappropriate for use in elderly patients.
The anti-depressant drugs Amitriptyline and doxepin accounted for 23 percent of claims for Beers list drugs, and 51 percent of those claims were for drugs with potentially harmful effects. More than 15 percent of patients filled prescriptions for two drugs of concern, and 4 percent filled prescriptions for three or more drugs of concern within the same year.
“The common use of potentially inappropriate drugs should serve as a reminder to monitor their use closely,” the authors concluded. “Pharmaceutical claims databases can be important tools for accomplishing this task, though clinical and laboratory data are needed to improve the sensitivity and specificity of patient-specific alerts.”
In an accompanying editorial, Knight Steel, M.D., of Hackensack University Medical Center in New Jersey, said the findings “bespeak a significant failure in the American health care system.”
Although the drugs included on the list may vary depending on the views of the members of the expert panel that devised it, Steel said if even half that number of elderly subjects is taking potentially inappropriate medications, then 1 in 10 of all older persons is at risk.
“The time has come to decrease the likelihood of inappropriate prescribing,” Steel added. “One way to begin is to include pharmacists in the process of prescription writing in a more meaningful way. Since they usually have information about patients’ age, pharmacists could be required to question the use of certain drugs or dosages in the elderly.”
“Perhaps the easiest and likely the best way of lowering the number of inappropriate prescriptions would be to design a computer program available to all pharmacists that identified all inappropriate prescriptions,” he added.
Source: Medical Week staff, August 9, 2004
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