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Potentially inappropriate prescribing to older adults in ambulatory care: prevalence and associated patient conditions

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Key summary points

AbstractSection Aim

To analyze potentially inappropriate prescribing (PIP), its prevalence and patient conditions associated with this phenomenon, in a cohort of older adults receiving outpatient care.

AbstractSection Findings

41.8% of participants had at least one PIP. The most frequently identified PIPs involved nonsteroidal anti-inflammatory drugs (NSAIDs) and glibenclamide; clonazepam in patients with cognitive impairment; and interactions of warfarin with NSAIDs. Frailty, polypharmacy, lower educational levels, and taking hypoglycemics, antiasthmatics, nervous system or gastrointestinal disease drugs, anti-inflammatories-antirheumatics and analgesics were associated with PIP.

AbstractSection Message

PIP, and association with medical and nonmedical factors in outpatient treatment highlights the need to take actions to improve drug treatment quality.

Abstract

Purpose

To analyze potentially inappropriate prescribing (PIP), its prevalence and patient conditions associated with this phenomenon, in a cohort of older adults receiving outpatient care in Mexico.

Methods

Data from 1252 adults ≥ 60 years of age, from primary care centers were analyzed. Information included sociodemographic data, medications, chronic diseases, polypharmacy (≥ 5 medications), functional dependence, cognitive impairment and frailty. Three logistic regression models were employed to identify associations between PIP (according to the Beers criteria) and different variable combinations.

Results

A total of 41.8% of participants had at least one PIP. The most frequently identified PIPs involved nonsteroidal anti-inflammatory drugs (NSAIDs) and glibenclamide; clonazepam in patients with cognitive impairment; and interactions of warfarin with NSAIDs. In the multivariate analyses, Model 1 showed that frailty and polypharmacy were associated with PIP. In Model 2, only polypharmacy was associated with PIP. For Model 3, lower educational levels, taking hypoglycemics, nervous system disease drugs, antiasthmatics, gastrointestinal disease drugs and anti-inflammatories-antirheumatics and analgesics, were associated with PIP.

Conclusion

PIP is common in outpatient treatment of health care services in Mexico. Its association with medical and nonmedical factors highlights the need to improve drug treatment quality focused on implementation of effective strategies, such as educative interventions, electronic medication safety alerts, and inclusion of pharmacists in the health team.

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Acknowledgements

We thank the authorities and staff of the South and North Delegations of the Mexican Institute of Social Security (IMSS) of Mexico City for their support for this study.

Funding

This work was funded by the Sector Fund Health Research and Social Security SS/IMSS/ISSSTE/CONACYT (México) SALUD-2013-01-201112, and the Fund for the Promotion of Health Research, IMSS, FIS/IMSS/PROT/PRIO/13/024. The funders had no role in the design, execution, analysis and interpretation of data, or writing of the study.

Author information

Authors and Affiliations

  1. Clinical Epidemiology Research Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico

    Dolores Mino-León

  2. Epidemiology and Health Services Research Unit, Aging Area, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico

    Sergio Sánchez-García

  3. Research Division, Demographic Epidemiology and Social Determinants Department, Instituto Nacional de Geriatría, Secretaría de Salud, Mexico City, Mexico

    Liliana Giraldo-Rodríguez

  4. Center for Health Systems Research, Instituto Nacional de Salud Pública, Avenida Universidad #655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico

    Hortensia Reyes-Morales

Authors
  1. Dolores Mino-León
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  2. Sergio Sánchez-García
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  3. Liliana Giraldo-Rodríguez
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  4. Hortensia Reyes-Morales
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Corresponding author

Correspondence to Hortensia Reyes-Morales.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The original study was approved by the National Scientific Research Committee (Comité Nacional de Investigación Científica) and the Health Research Ethics Committee (Comité de Ética en Investigación en Salud), both part of the IMSS, with registry number 2012-785-067. This article does not contain any studies with human participants performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the original study (COSFOMA). The data used in this study were anonymous.

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Mino-León, D., Sánchez-García, S., Giraldo-Rodríguez, L. et al. Potentially inappropriate prescribing to older adults in ambulatory care: prevalence and associated patient conditions. Eur Geriatr Med 10, 639–647 (2019). https://doi.org/10.1007/s41999-019-00181-5

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  • DOI: https://doi.org/10.1007/s41999-019-00181-5

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