Colleagues, the following is FYI and does not necessarily reflect my own
opinion. I have no further knowledge of the topic.
------------------------
Study examines inappropriate medication prescribing for elderly patients
http://www.eurekalert.org/pub_releases/2004-08/jaaj-sei080504.php
To contact corresponding author Kevin A. Schulman, M.D., call Kendall
Morgan at 919-684-4148. To contact editorialist Knight Steel, M.D., call
Anne Marie Campbell at 201-996-3763.
CHICAGO – Prescribing of inappropriate medications for elderly patients
appears relatively common, according to an article in the August 9/23
issue of The Archives of Internal Medicine, one of the JAMA/Archives
journals.
According to information in the article, persons 65 years or older make
up less than 15 percent of the population, but make up nearly one-third
of prescription drug users. Elderly persons are also more likely to take
several drugs concurrently, the article states.
Lesley H. Curtis, Ph.D., of Duke University Medical Center, Durham,
N.C., and colleagues investigated the extent of potentially
inappropriate medication prescribing for elderly patients not in the
hospital. Inappropriate medications were identified according to
criteria set by physicians and pharmacologists, as defined by a list
known as the Beers revised list of drugs – a list of drugs to be avoided
in the elderly.
The researchers studied the outpatient claims database of a large
national pharmaceutical benefit company. The database included 765,423
patients aged 65 or older who filled one or more prescription drug
claims during 1999.
The researchers found that 162,370 patients (21 percent) filled a
prescription for one or more drugs of concern (medications that should
be avoided in elderly patients or which are inappropriate for use in
elderly patients). Amitriptyline and doxepin (drugs used for treatment
of depression) 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 write.
"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."
(Arch Intern Med. 2004;164:1621-1625. Available post-embargo at
http://www.archinternmed.com). Editor's Note: This work was supported by
a Centers for Education and Research on Therapeutics cooperative
agreement between the Agency for Healthcare Research and Quality,
Rockville, Md., and the University of Arizona Health Sciences Center,
Tuscon.
Editorial: The Time to Act Is Now
In an accompanying editorial, Knight Steel, M.D., of Hackensack
University Medical Center, New Jersey, writes that the article by Curtis
et al, "bespeaks a significant failure in the American health care
system. Using a 1999 claims database of over three quarters of a million
elderly subjects from a national pharmaceutical benefit manager, they
report that 21 percent of this population filled a prescription for a
drug deemed to be potentially inappropriate for this age group by an
expert panel. Although the drugs included on such a list may vary
depending on the views of the members of the panel, if even half that
number of elderly subjects are taking potentially inappropriate
medications, one in ten of all older persons is receiving a drug that is
potentially not appropriate."
Dr. Steel states that whatever the reason for the high rates of
inappropriate prescribing to elderly patients, "the time has come to
decrease the likelihood of inappropriate prescribing."
"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."
Dr. Steel suggests, "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."
(Arch Intern Med. 2004;164:1603-1604. Available post-embargo at
http://www.archinternmed.com)
--
Kathrynne Holden, MS, RD < [log in to unmask] >
"Ask the Parkinson Dietitian" http://www.parkinson.org/
"Eat well, stay well with Parkinson's disease"
"Parkinson's disease: Guidelines for Medical Nutrition Therapy"
http://www.nutritionucanlivewith.com/
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