1027. Potentially Inappropriate Prescribing for Older Veterans: Who's at risk?
Mary Jo Pugh, PhD, RN, CHQOER, Bedford VAMC, G Fincke, CHQOER, Bedford VAMC, A Bierman,
University of Toronto, F Cunningham,
VA Pharmacy Benefit Strategic Management Group, Hines VAMC, BH Chang,
CHQOER, Bedford VAMC, M Amuan,
CHQOER, Bedford VAMC, DR Berlowitz,
CHQOER, Bedford VAMC
Objectives: Potentially inappropriate prescribing for the elderly (PIPE) is an important patient safety concern. Previous studies indicating that 20% of community-dwelling elderly experience PIPE did not consider appropriate diagnostic indications for these medications. Thus, we used diagnostic data to assess PIPE in the VA, and identify those at greatest risk.
Methods: We merged demographic and diagnostic data from the National Patient Care Database and national pharmacy data for veterans <65 years (FY00). We identified those receiving potentially inappropriate drugs, and those having diagnoses for indications deemed appropriate (AHRQ expert panel). Logistic regression identified those at greatest risk of PIPE.
Results: Using diagnostic information, 17% of older veterans received a potentially inappropriate drug. Women and younger individuals were more likely to experience PIPE (OR 1.30; 95% CIís 1.24-1.32, 1.28-1.35 respectively). Those who received specialty geriatric care were less likely to experience PIPE (OR .78; 95% CI .76-.80).
Conclusions: A substantial number of older veterans receive potentially inappropriate drugs. Predictors of PIPE are similar in VA and non-VA studies, however, additional data allowed more accurate identification of those receiving potentially inappropriate drugs and those at greatest risk.
Impact: Adverse effects from PIPE may place older veterans at unnecessary risk of injury. Research is needed to identify barriers to reducing PIPE and develop interventions to decrease PIPE within the VA. However, this study suggests that, despite greater disease burden, older veterans receiving specialized geriatric care are at lower risk of PIPE. Thus, evaluation of geriatric care may be an important place to start.