Racial Disparities in the Quality of Medication Use in Older Adults: Baseline Findings from a Longitudinal Study
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Medication-related problems are prevalent in older adults and adversely affect the quality of care. It has been suggested that racial differences exist in medication use. Most efforts to evaluate the quality of medication use target specific drugs or disease states, or a set of pre-defined quality indicators, rather than the patient.
We conducted a prospective cohort study to determine the prevalence and types of medication-related problems in older adults, examining the impact of race on quality medication use.
In-home interviews and medical record reviews of 200 (100 white, 100 black) older adults were conducted three times over 1 year. The quality of medication use was measured using a clinical pharmacist’s assessment of quality and the Assessing Care of Vulnerable Elders quality indicators. We used logistic and negative binomial regression models to analyze the two primary endpoints of prevalence and number of medication-related problems.
Mean age was 78.3 (whites) and 75.5 (blacks), with the majority being female. Although whites used more medications than blacks (11.6 versus 9.7; p < 0.01), blacks had more medication-related problems per person than whites (6.2 versus 4.9; p < 0.01). All patients had at least one medication-related problem; undertreatment, suboptimal drug, suboptimal dosing, and nonadherence were most prevalent. Blacks had significantly higher rates of nonadherence than whites (68% versus 42%; p < 0.01).
Medication-related problems are prevalent in community-residing older adults. Blacks had more medication-related problems than whites, including higher rates of nonadherence. These findings require further study to better understand racial disparities in quality medication use.
- Hohl CM, Dankoff J, Colacone A, Afilalo M. Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department. Ann Emerg Med. 2001;38:666–71. CrossRef
- Higashi T, Shekelle PG, Adams JL, et al. Quality of care is associated with survival in vulnerable older patients. Ann Intern Med. 2005;143:274–81.
- Landi F, Russo A, Liperoti R, et al. Anticholinergic drugs and physical function among frail elderly population. Clin Pharmacol Ther. 2007;81:235–41. CrossRef
- Fu AZ, Jiang JZ, Reeves JH, Fincham JE, Lin GG, Perri M. Potentially inappropriate medication use and healthcare expenditures in the US community-dwelling elderly. Med Care. 2007;45:472–6. CrossRef
- Johnson JA, Bootman JL. Drug-related morbidity and mortality and the economic impact of pharmaceutical care. Am J Health Syst Pharm. 1997;54:554–8.
- Ernst FR, Grizzle AJ. Drug-related morbidity and mortality: Updating the cost-of-illness model. J Am Pharm Assoc. 2001;41:192–9.
- Johnson JA, Bootman JL. Drug-related morbidity and mortality. A cost-of-illness model. Arch Intern Med. 1995;155:1949–56. CrossRef
- Smedley BD, Stith AY, Nelson AR, eds, for the Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, the Board on Health Sciences Policy, and the Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academy Press; 2003.
- Gaskin DJ, Briesacher BA, Limcangco R, Brigantti BL. Exploring racial and ethnic disparities in prescription drug spending and use among Medicare beneficiaries. Am J Geriatr Pharmacother. 2006;4:96–111. CrossRef
- Saha S, Freeman M, Toure J, Tippens KM, Weeks C, Ibrahim S. Racial and ethnic disparities in the VA health care system: a systematic review. J Gen Intern Med. 2008;23:654–71. CrossRef
- Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163(22):2716–24. CrossRef
- Knight EL, Avorn J. Quality indicators for appropriate medication use in vulnerable elders. Ann Intern Med. 2001;135:703–10.
- Lohr KN, ed, for the Committee to Design a Strategy for Quality Review and Assurance in Medicare, the Division of Health Care Services, and the Institute of Medicine. Medicare: A Strategy for Quality Assurance. Washington, DC: National Academy Press; 1990.
- Chassin MR. Quality of care. Time to act. JAMA. 1991;266:3472–3. CrossRef
- Roth MT, Moore CG, Ivey JL, Esserman DA, Campbell WH, Weinberger M. The quality of medication use in older adults: methods of a longitudinal study. Am J Geriatr Pharmacother. 2008;6:220–33. CrossRef
- Callahan CM, Unverzagt FW, Hui SL, Perkins AJ, Hendrie HC. Six-item screener to identify cognitive impairment among potential subjects for clinical research. Med Care. 2002;40:771–81. CrossRef
- Baker DW, Williams MV, Parker RM, Gazmararian JA, Nurss J. Development of a brief test to measure functional health literacy. Patient Educ Couns. 1999;38:33–42. CrossRef
- Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179–86.
- Strand LM, Morley PC, Cipolle RJ, Ramsey R, Lamsam GD. Drug-related problems: their structure and function. DICP. 1990;24:1093–7.
- Shrank WH, Polinski JM, Avorn J. Quality indicators for medication use in vulnerable elders. J Am Geriatr Soc. 2007;55(Suppl 2):S373–82. CrossRef
- Kerr EA, Smith DM, Hogan MM, et al. Building a better quality measure: are some patients with poor quality actually getting good care? Med Care. 2003;41(10):1173–82. CrossRef
- Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74. CrossRef
- Pagona M, Gauvreau K, eds. Principles of Biostatistics. 2nd ed. Pacific Grove, Calif: Duxbury; 2000.
- Hanlon JT, Weinberger M, Samsa GP, et al. A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy. Am J Med. 1996;100(4):428–37. CrossRef
- Fillenbaum GG, Hanlon JT. Racial and ethnic disparities in medication use among older adults. Am J Geriatr Pharmacother. 2006 Jun;4(2):93–5. CrossRef
- Murray MD, Young J, Hoke S, et al. Pharmacist intervention to improve medication adherence in heart failure: a randomized trial. Ann Intern Med. 2007 May 15;146(10):714–25.
- Shrank WH, Asch SM, Adams J, et al. The quality of pharmacologic care for adults in the United States. Med Care. 2006;44:936–45. CrossRef
- Ostrom JR, Hammarlund ER, Christensen DB, Plein JB, Kethley AJ. Medication usage in an elderly population. Med Care. 1985 Feb;23(2):157–64. CrossRef
- Alkema GE, Wilber KH, Simmons WJ, Enguidanos SM, Frey D. Prevalence of potential medication problems among dually eligible older adults in Medicaid waiver services. Ann Pharmacother. 2007 Dec;41(12):1971–8. CrossRef
- Cipolle RJ, Strand LM, Morley PC, eds. Pharmaceutical Care Practice. New York, NY: McGraw-Hill; 2004.
- Kassam R, Farris KB, Burback L, Volume CI, Cox CE, Cave A. Pharmaceutical care research and education project: pharmacists' interventions. J Am Pharm Assoc. 2001;41(3):401–10.
- Racial Disparities in the Quality of Medication Use in Older Adults: Baseline Findings from a Longitudinal Study
Journal of General Internal Medicine
Volume 25, Issue 3 , pp 228-234
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Campus Box 7360, Kerr Hall, Chapel Hill, NC, 27599-7360, USA
- 2. Division of General Medicine and Clinical Epidemiology, School of Medicine and Department of Biostatistics, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- 3. Division of Pharmacy Practice and Experiential Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- 4. Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina and Senior Career Scientist, Durham VAMC Center for Health Services Research, Durham, NC, USA