Potentially Inappropriate Prescribing for the Elderly

BACKGROUND: Many studies have identified patient characteristics associated with potentially inappropriate prescribing in the elderly (PIPE), however, little attention has been directed toward how health care system factors such as geriatric care may affect this patient safety issue. OBJECTIVE: This study examines the association between geriatric care and PIPE in a community dwelling elderly population. RESEARCH DESIGN: Cross-sectional retrospective database study. SUBJECTS: Veterans age > or =65 years who received health care in the VA system during Fiscal Years (FY99-00), and also received at medications from the Veterans Administration in FY00. MEASURES: PIPE was identified using the Zhan adaptation of the Beers criteria. Geriatric care penetration was calculated as the proportion of patients within a facility who received at least 1 geriatric outpatient clinic or inpatient visit. ANALYSES: Logistic regression models with generalized estimating equations were used to assess the relationship between geriatric care and PIPE after controlling for patient and health care system characteristics. RESULTS: Patients receiving geriatric care were less likely to have PIPE exposure (odds ratio, 0.64; 95% confidence interval, 0.59-0.73). There was also a weak effect for geriatric care penetration, with a trend for patients in low geriatric care penetration facilities having higher risk for PIPE regardless of individual geriatric care exposure (odds ratio, 1.14; 95% confidence interval, 0.99-1.30). CONCLUSIONS: Although geriatric care is associated with a lower risk of PIPE, additional research is needed to determine if heterogeneity in the organization and delivery of geriatric care resulted in the weak effect of geriatric care penetration, or whether this is a result of low power

Ambulatory care · Confidence interval · Geriatric care · Geriatrics · Health care · Logistic regression · Odds ratio · Psychiatry · Emergency Medicine · Frailty in Older Adults · Internal Medicine · Medicine · Nursing · Nursing Roles and Practices · Pharmaceutical Practices and Patient Outcomes

• Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases

  Open Access•Richard A Deyo, R DEYO•Journal of Clinical Epidemiology•1992

  Incluir item

• The Implications of Regional Variations in Medicare Spending. Part 1

  Open Access•Elliott S Fisher, David E Wennberg et al.•Annals of Internal Medicine•2003

  Incluir item

• Veterans Health Administration and Medicare Outpatient Health Care Utilization by Older Rural and Urban New England Veterans

  Open Access•William B Weeks, David M Bott et al.•The Journal of Rural Health•2005

  Incluir item

• Risk-Adjusted Mortality as an Indicator of Outcomes

  Alfredo J Selim, Lewis E Kazis et al.•Medical Care•2006

  Incluir item