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Primary care physicians’ behaviors towards risk of iatrogenesis in elderly patients

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Objectives

Iatrogenesis is common in elderly patients. This phenomenon could be reduced by improving awareness of general practitioners (GPs). We studied GPs’ prescribing behavior to elderly patients, to identify GP and patient characteristics related to cautious prescribing behaviors.

Methods

The observational study sampled 106 GPs who had consecutively recruited, on average, 12 patients over 75 years of age. GPs completed a questionnaire on their practice and a questionnaire for each patient they recruited, describing their usual care of elderly patients, and criteria for prescribing therapy. GPs’ behaviors were studied with five scores and a global prescribing behavior (adequate/inadequate). The relationship between patients’ risk of iatrogenesis and GPs’ behaviors was studied with hierarchical logistic models.

Results

A total of 106 GPs recruited 1,318 patients (mean age 80.7 years, 36% males). A wide variety of behaviors was observed among GPs. Only 40% of GPs had specific prevention-oriented visits, while only 19.2% considered that prevention was optimally implemented in their practice. On average, GPs had behaviors considered adequate in about half of encounters. GPs’ global behaviors were more likely to be adequate for patients at higher risk (OR=1.47, 95%CI: 1.10–1.95). Likewise, before prescribing to patients at higher risk of iatrogenesis, GPs were more likely to collect data on financial autonomy, on clinical/biological data, and to adopt good prescription practices, while less attention was paid to patients’ physical and psychological autonomy.

Conclusions

GPs tended to be more cautious when prescribing to patients at higher iatrogenesis risk. However, overall prescribing behaviors were not optimal. Efforts are needed to improve the quality of care in elderly patients.

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Acknowledgements

This study was supported by the Fond of Help for the Quality of Care in urban areas (FAQSV), in collaboration with the Association for the Development of Medical Information (ADIM). Carol Tozzi, PhD, kindly reviewed and improved the manuscript. We would like to thank the reviewers for their helpful comments. They contributed to greatly improve our manuscript. The study has been conducted in accordance with the current laws in France and the protocol was approved by the ethic committee.

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Authors and Affiliations

  1. ADIM, Lyon, France

    Bruno Fantino

  2. Pharmacoepidemiology, EA 3091, CHU-Lyon, Lyon, France

    Nicolas Voirin, Laurent Laforest, Stephanie Chretin & Eric Van Ganse

  3. AGORAS, Lyon, France

    Francoise Fantino

  4. Faculté de Médecine Lyon-Sud, BP 12, 165 Chemin du Grand Revoyet, F-69921, Oullins Cedex, France

    Eric Van Ganse

Authors
  1. Bruno Fantino
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  2. Nicolas Voirin
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  3. Laurent Laforest
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  4. Francoise Fantino
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  5. Stephanie Chretin
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  6. Eric Van Ganse
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Corresponding author

Correspondence to Eric Van Ganse.

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Fantino, B., Voirin, N., Laforest, L. et al. Primary care physicians’ behaviors towards risk of iatrogenesis in elderly patients. Eur J Clin Pharmacol 62, 563–570 (2006). https://doi.org/10.1007/s00228-006-0125-z

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  • DOI: https://doi.org/10.1007/s00228-006-0125-z

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