Suboptimal prescribing in elderly outpatients: potentially harmful drug-drug and drug-disease combinations.

Abstract:

OBJECTIVES:To assess the prevalence and correlates of potentially harmful drug-drug combinations and drug-disease combinations prescribed for elderly patients at outpatient settings. DESIGN:Retrospective analysis of the 1995-2000 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS). SETTING:Physician offices and hospital outpatient departments. PARTICIPANTS:Outpatient visits by patients aged 65 and older in the NAMCS and NHAMCS (n=70,203). MEASUREMENTS:Incidences of six drug-drug combinations and 50 drug-disease combinations that can place elderly patients at risk for adverse events according to expert consensus panels. RESULTS:Overall, 0.74% (95% confidence interval (CI)=0.65-0.83) of visits with two or more prescriptions had at least one inappropriate drug-drug combination, and 2.58% (95% CI=2.44-2.72) of visits with at least one prescription had one or more inappropriate drug-disease combinations. Of visits with a prescription of warfarin, 6.60% (95% CI=5.46-7.74) were prescribed a drug with potentially harmful interaction. Of patients with benign prostatic hypertrophy, 4.06% (95% CI=3.06-5.06) had at least one of six drugs that should be avoided. The number of drugs prescribed is most predictive of inappropriate drug-drug and drug-disease combinations. CONCLUSION:Potentially harmful drug-drug and drug-disease combinations occur in various degrees in outpatient care in the elderly population. Targeting combinations such as those involving warfarin that are high in prevalence and potential harm offers a practical approach to improving prescribing and patient safety.

journal_name

J Am Geriatr Soc

authors

Zhan C,Correa-de-Araujo R,Bierman AS,Sangl J,Miller MR,Wickizer SW,Stryer D

doi

10.1111/j.1532-5415.2005.53112.x

subject

Has Abstract

pub_date

2005-02-01 00:00:00

pages

262-7

issue

2

eissn

0002-8614

issn

1532-5415

pii

JGS53112

journal_volume

53

pub_type

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