The Association of Potentially Inappropriate Medication Use with Adverse Outcomes among Elderly Outpatients with Chronic Illnesses
Date Issued
2005
Date
2005
Author(s)
Lin, Hsi-Yen
DOI
zh-TW
Abstract
BACKGROUND: The issue of patient safety and the quality of healthcare is of great concern, and the important target is the safety of medication use. For elderly patients with chronic illnesses, due to a number of medications needed for long-term use, the safety and the appropriateness of medication use should be of upmost concern. Previous studies using different measures to evaluate medication appropriateness among elderly had indicated the prevalence and the risk factors of inappropriate use, but little information is known about the relationship between inappropriate medication use and their adverse outcomes.
OBJECTIVE: To identify the prevalence and the risk factors of potentially inappropriate medication use among elderly ambulatory patients with chronic diseases, and to explore the possible associations between potentially inappropriate medication use and the risk of developing adverse outcomes.
METHODS: Ambulatory elderly patients who had 3-month refill prescription in a medical center were recruited consecutively during the enrollment period （March 1-31, 2005）. Data of the adverse outcomes including emergency visits, hospitalizations and mortality for the coming 6 months after inclusion were collected. Beer criteria-2002 （an explicit criteria）was used to judge the appropriateness in this observational cohort study.
RESULTS: The prevalence was 20.97%（incidents in a total of 5,741 patients or in 7,538 visits）, where 88.11% elderly received one inappropriate medication and other 11.89% had two or more inappropriate medications. The most frequent inappropriate medication of high severity were amiodarone, bisacodyl, nifedipine, amitriptyline and chlorzoxazone；those of low severity were dipyridamole, doxazosin and digoxin.
Logistic regression revealed that gender (OR 1.18, 95% CI 1.01 to 1.35), age (OR 1.02, 95% CI 1.01 to 1.03), the number of chronic diseases (OR 1.13, 95% CI 1.03 to 1.24), the number of medications taken (OR 1.37, 95% CI 1.32 to 1.42), and the number of refill prescriptions received within the same month (OR 1.43, 95% CI 1.28 to 1.59), all significantly increased the likelihood of receiving inappropriate medications. Otherwise, when family physicians were used as the reference, the patients receiving prescriptions from nephrologist (OR 4.15, 95% CI 2.81to 6.13), psychiatrist (OR 2.34, 95% CI 1.41 to 3.87), surgeon (OR 2.31, 95% CI 1.64 to 3.24), rheumatologist (OR 1.89, 95% CI 1.25 to 2.88), and cardiologist (OR 1.35, 95% CI 1.01 to 1.80) were significantly in higher risk to have inappropriate medications.
The incidence of adverse outcomes within the study period was 19.29%, where 10.86% patients visited the emergency department, 8.12% patients hospitalized and 0.31% patients died. Inappropriate medication use increased the likelihood of emergency visit and hospitalization, but with no correlation in mortality. Inappropriate medication use also increased the expenditures of emergency visit and mortality, but no difference was seen in hospitalization. Logistic regression revealed that inappropriate medication use did not increase the risk of emergency visit or mortality, but had significant association with hospitalization（OR 1.62, 95% CI 1.04 to 2.53）.
CONCLUSIONS: Potentially inappropriate medication use was common among elderly ambulatory patients of chronic diseases. Many factors were found to increase the risk of receiving inappropriate medications among elderly of chronic diseases. Inappropriate medication use is associated with a higher risk of hospitalization.
Subjects
老年人
慢性病連續處方箋
潛在性不適當藥物
明確列舉式評估準則
不良結果
elderly
refill prescription
potentially inappropriate medication use
explicit criteria
adverse outcomes
Type
thesis
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