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Potentially inappropriate prescribing for older veterans: who's at risk of receiving the wrong drug, wrong dose, and wrong duration

Pugh MJ, Fincke BG, Bierman A, Cunningham F, Chang BH, Amuan M, Rosen AK, Burk M, Berlowitz DR. Potentially inappropriate prescribing for older veterans: who's at risk of receiving the wrong drug, wrong dose, and wrong duration. Paper presented at: Gerontological Society of America Annual Scientific Meeting; 2004 Nov 22; Washington, DC.

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Abstract:

OBJECTIVE: Potentially inappropriate prescribing for the elderly (PIPE) is an important patient safety concern. Data limitations in previous studies precluded identifying inappropriate use of dose-dependent drugs, and assessing appropriateness for drugs identified as having appropriate indications. We used Department of Veterans Affairs (VA) data to assess PIPE, and identify those at greatest risk in the VA. METHODS: We merged demographic and diagnostic data from the National Patient Care Database and national pharmacy data for veterans > 65 years and identified those receiving potentially inappropriate drugs. Those having diagnoses for appropriate indications identified by an Agency for Healthcare Research and Quality expert panel, or receiving doses below geriatric recommendations were considered to have appropriate use of these drugs; others were identified as Probably Inappropriate Prescribing in the Elderly (PIPE2). We used logistic regression to identify patient, provider, and healthcare system factors associated with receiving of PIPE2. RESULTS: 20.52% of older veterans experienced PIPE2. Patients receiving more medications were more likely to experience PIPE2 (OR 1.27; 95% CI 1.27-1.27). Those who received specialty geriatric care were less likely to experience PIPE2 (OR .63; 95% CI .61-.65). CONCLUSIONS: A substantial number of older veterans receive potentially inappropriate drugs, exposing them to risk for injury, hospitalization, and death. Research is needed to identify barriers to reducing PIPE and develop interventions to decrease PIPE. Because this study suggests that older patients receiving specialized geriatric care are at lower risk of PIPE, increasing access to geriatric care may be an important place to start.





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