Potentially inappropriate drug prescription in the elderly in France: a population-based study from the French National Insurance Healthcare system
Inappropriate prescribing is a known risk factor for adverse drug event occurrence in the elderly. In various countries, several studies have used insurance healthcare databases to estimate the national prevalence of potentially inappropriate medications (PIM) in the elderly, as defined by explicit PIM lists. Recently, a representative sample of the French National Insurance Healthcare database, known as the “Echantillon Généraliste des Bénéficiaires” (EGB), was created, making it possible to assess the quality of drug prescription in France. Our objective was to evaluate the prevalence and the regional distribution of PIM prescription in the elderly aged 75 years and over in France, using the French PIM list and the EGB database.
The list of drugs reimbursed to patients aged 75 years and over from 1 March 2007 to 29 February 2008 was extracted from the EGB. Drugs were classified as inappropriate using the French PIM list. A PIM user was defined as a person receiving at least one PIM reimbursement during the study period. Interregion variability was estimated from logistic regression.
In 53.6% (95% CI: 53.0–54.1) of the elderly aged 75 years and over, at least one PIM was given during the study period. The three main drug groups identified were cerebral vasodilators (19.4%), drugs with antimuscarinic properties (19.3%), and long half-life benzodiazepines (17.8%). There was an important disparity in PIM prescription among the French regions. In 14 out of 22 regions, the risk of PIM prescription was significantly elevated. This geographical variation differed for the different drug groups.
PIM prescription in the elderly is a major and worrying problem in France. As in other countries, recent accessibility of the National Insurance Healthcare database makes it possible to create local indicators that the regional health agencies could use to manage public health policy in closer alignment to the needs of the patients within each French region.
KeywordsInappropriate medication Elderly Prescription Reimbursement database France Geographic variation
- 2.Ministère de la Santé (2004) Loi n°2004–806 du 09 août 2004, relative à la politique de santé publique. Journal OfficielGoogle Scholar
- 5.Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH (2003) Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 163(22):2716–2724. doi:10.1001/archinte.163.22.2716163/22/2716 PubMedCrossRefGoogle Scholar
- 9.Barry PJ, O'Keefe N, O'Connor KA, O'Mahony D (2006) Inappropriate prescribing in the elderly: a comparison of the Beers criteria and the improved prescribing in the elderly tool (IPET) in acutely ill elderly hospitalized patients. J Clin Pharm Ther 31(6):617–626. doi:10.1111/j.1365-2710.2006.00783.x PubMedCrossRefGoogle Scholar
- 10.Bongue B, Naudin F, Laroche ML, Galteau MM, Guy C, Gueguen R, Convers JP, Colvez A, Maarouf N (2009) Trends of the potentially inappropriate medication consumption over 10 years in older adults in the East of France. Pharmacoepidemiol Drug Saf 18(12):1125–1133. doi:10.1002/pds.1762 PubMedCrossRefGoogle Scholar
- 11.Fialova D, Topinkova E, Gambassi G, Finne-Soveri H, Jonsson PV, Carpenter I, Schroll M, Onder G, Sorbye LW, Wagner C, Reissigova J, Bernabei R (2005) Potentially inappropriate medication use among elderly home care patients in Europe. JAMA 293(11):1348–1358. doi:10.1001/jama.293.11.1348293/11/1348 PubMedCrossRefGoogle Scholar
- 21.Roquefeuil LD (2009) L'échantillon généraliste des bénéficiares: représentativité, portée et limites. Prat Organ Soins 40(3):213–223Google Scholar
- 24.Lechevallier-Michel N, Gautier-Bertrand M, Alperovitch A, Berr C, Belmin J, Legrain S, Saint-Jean O, Tavernier B, Dartigues JF, Fourrier-Reglat A (2005) Frequency and risk factors of potentially inappropriate medication use in a community-dwelling elderly population: results from the 3C Study. Eur J Clin Pharmacol 60(11):813–819. doi:10.1007/s00228-004-0851-z PubMedCrossRefGoogle Scholar
- 25.Bouvenot G (2003) Etude de la prescription et de la consommation des vasodilatateurs en ambulatoire. Afssaps, Saint DenisGoogle Scholar
- 26.Chevreul K (2009) HTA in coverage and reimbursement decisions in France: toward a new paradigm? Euro Observer 11:5–6Google Scholar
- 27.Ness J, Hoth A, Barnett MJ, Shorr RI, Kaboli PJ (2006) Anticholinergic medications in community-dwelling older veterans: prevalence of anticholinergic symptoms, symptom burden, and adverse drug events. Am J Geriatr Pharmacother 4(1):42–51. doi:10.1016/j.amjopharm.2006.03.008 PubMedCrossRefGoogle Scholar
- 35.Kumar A, Fonarow GC, Eagle KA, Jirsch AT, Califf RM, Alberts MJ, Boden WE, Steg PG, Shao M, Bhatt DL, Cannon CP, Investigators REACH (2009) Regional and practice variation in adherence to guideline recommendations for secondary and primary prevention among outpatients with atherothrombosis or risk factors in the United States: a report from the REACH Registry. Crit Pathw Cardiol 8(3):104–111PubMedCrossRefGoogle Scholar
- 38.Lopez J, Meier J, Cunningham F, Siegel D (2004) Antihypertensive medications use in the Department of Veterans Affairs: a national analysis of prescribing patterns from 2000–2002. Am J Hypertens 17:1095–1099Google Scholar
- 39.Lecadet J (2003) Médicaments psychotropes: consommation et pratiques de prescription en France métropolitaine. II Données de comparaison régionales, 2000. Med Ass Maladie 34(4):233–248Google Scholar