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Risk factors for the prescription of potentially inappropriate medication (PIM) in the elderly

An analysis of sickness fund routine claims data from Germany

Risikofaktoren für die Verschreibung potenziell inadäquater Medikation (PIM) bei älteren Patienten in Deutschland

Eine Analyse von GKV-Routinedaten an Hand der Kriterien der PRISCUS-Liste

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Summary

Elderly people are especially prone to suffer adverse drug reactions (ADR). Main reasons for the higher vulnerability of the elderly to ADR are changes in metabolism as i.e. slower renal clearance and polypharmacie which often results from multimorbidity. To prevent ADR careful prescription with special consideration of these aspects is warranted. To help physicians avoid drugs which are especially likely to cause ADR lists have been developed following the consensus method process. For Germany this list is called the PRISCUS list. It was developed based on a literature review, review of international lists such as the American Beers list, and a consensus process based on a Delphi survey. It contains 83 drugs from 18 classes which are classified as potentially inapropriate medication (PIM). It also lists alternatives for each PIM. If a drug is registered with the PRISCUS list this does not mean automatically that it is contraindicated in the elderly but that special caution should be excercised in prescribing the drug, alternatives should be considered and the patient carefully monitored.

Prescription rates for PIMs in Germany in the elderly is pretty much stable at around 23% with only a small decline in the past years. Also, more than 5% of all prescriptions in the elderly are PIM prescriptions. Physicians specially trained in geriatrics tend to prescribe less PIMs compared to other physicians.

Zusammenfassung

Unerwünschte Arzneimittelwirkungen (UAW) sind für rund 5% aller Krankenhauseinweisungen in Deutschland verantwortlich. Insbesondere ältere Menschen sind durch Veränderungen im Metabolismus sowie durch Medikamenteninteraktionen aufgrund von Polypharmazie gefährdet. Um UAWs zu vermeiden, wurde in den USA in den 1990er Jahren im Delphi-Konsensusverfahren eine Liste mit potentiell inadäquaten Medikamenten (PIMs) für ältere Menschen entwickelt, die sog. Beers-Liste. In Deutschland existiert seit Kurzem eine an die deutsche Versorgungsrealität angepasste Liste mit potentiell inadäquaten Medikamenten für ältere Personen, die sogenannte PRISCUS Liste. Sie basiert auf einem systematischen Literaturreview, einem Review international vorhandener Listen, wie z. B. der Beers Liste und einem Delphi-Konsensusprozess. Sie enthält 83 Arzneistoffe aus 18 Arzneistoffklassen welche als potenziell inadäquat für ältere Patienten eingestuft wurden. Die in der PRISCUS Liste aufgeführten Medikamente sind bei älteren Patienten nicht automatisch kontraindiziert. Vielmehr sollte bei ihrer Verschreibung besondere Sorgfalt verwendet, Alternativen geprüft bzw. ein intensives Monitoring durchgeführt werden.

In Deutschland erhalten 23% aller älteren Menschen mindestens ein PIM, mit einem unwesentlichen Rückgang in den vergangenen Jahren. Somit sind mehr als 5% aller Verschreibungen bei älteren Menschen PIMs. Ärzte mit einer Fortbildung in Geriatrie tendieren zu einer niedrigeren Verschreibungsrate im Vergleich zu anderen Ärzten.

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Acknowledgements

This study was funded by the Dr. Werner-Jackstädt-Stiftung.

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The authors declare that there is no conflict of interest.

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Authors and Affiliations

  1. Institut für Gesundheitsökonomie und Klinische Epidemiologie der Universität zu Köln, Gleueler Str. 176–178, 50935, Köln, Germany

    Stephanie Stock MD,  Marcus Redaelli MD, Dusan Simic & Frank Henschel

  2. Management im Gesundheitswesen, Technische Universität Berlin, Berlin, Germany

    Martin Siegel PhD

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  1. Stephanie Stock MD
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  2. Marcus Redaelli MD
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Correspondence to Stephanie Stock MD.

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Stock, S., Redaelli, M., Simic, D. et al. Risk factors for the prescription of potentially inappropriate medication (PIM) in the elderly. Wien Klin Wochenschr 126, 604–612 (2014). https://doi.org/10.1007/s00508-014-0589-2

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  • DOI: https://doi.org/10.1007/s00508-014-0589-2

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