Prescriber variation in potentially inappropriate prescribing in older populations in Ireland

Hdl Handle:
http://hdl.handle.net/10147/315278
Title:
Prescriber variation in potentially inappropriate prescribing in older populations in Ireland
Authors:
Cahir, Caitriona; Fahey, Tom; Teljeur, Conor; Bennett, Kathleen
Citation:
BMC Family Practice. 2014 Apr 02;15(1):59
Issue Date:
2-Apr-2014
URI:
http://dx.doi.org/10.1186/1471-2296-15-59; http://hdl.handle.net/10147/315278
Abstract:
Abstract Background Health care policy-makers look for prescribing indicators at the population level to evaluate the performance of prescribers, improve quality and control drug costs. The aim of this research was to; (i) estimate the level of variation in potentially inappropriate prescribing (PIP) across prescribers in the national Irish older population using the STOPP criteria; (ii) estimate how reliably the criteria could distinguish between prescribers in terms of their proportion of PIP and; (iii) examine how PIP varies between prescribers and by patient and prescriber characteristics in a multilevel regression model. Methods 1,938 general practitioners (GPs) with 338,375 registered patients’ ≥70 years were extracted from the Health Service Executive Primary Care Reimbursement Service (HSE-PCRS) pharmacy claims database. HSE-PCRS prescriptions are WHO ATC coded. Demographic data for claimants’ and prescribers’ are available. Thirty STOPP indicators were applied to prescription claims in 2007. Multilevel logistic regression examined how PIP varied between prescribers and by individual patient and prescriber level variables. Results The unadjusted variation in PIP between prescribers was considerable (median 35%, IQR 30-40%). The STOPP criteria were reliable measures of PIP (average >0.8 reliability). The multilevel regression models found that only the patient level variable, number of different repeat drug classes was strongly associated with PIP (>2 drugs v none; adjusted OR, 4.0; 95% CI 3.7, 4.3). After adjustment for patient level variables the proportion of PIP varied fourfold (0.5 to 2 times the expected proportion) between prescribers but the majority of this variation was not significant. Conclusion PIP is of concern for all prescribers. Interventions aimed at enhancing appropriateness of prescribing should target patients taking multiple medications.
Item Type:
Article
Language:
en
Keywords:
PRESCRIBING; OLDER PEOPLE

Full metadata record

DC FieldValue Language
dc.contributor.authorCahir, Caitrionaen_GB
dc.contributor.authorFahey, Tomen_GB
dc.contributor.authorTeljeur, Conoren_GB
dc.contributor.authorBennett, Kathleenen_GB
dc.date.accessioned2014-04-03T15:40:29Z-
dc.date.available2014-04-03T15:40:29Z-
dc.date.issued2014-04-02-
dc.identifier.citationBMC Family Practice. 2014 Apr 02;15(1):59en_GB
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2296-15-59-
dc.identifier.urihttp://hdl.handle.net/10147/315278-
dc.description.abstractAbstract Background Health care policy-makers look for prescribing indicators at the population level to evaluate the performance of prescribers, improve quality and control drug costs. The aim of this research was to; (i) estimate the level of variation in potentially inappropriate prescribing (PIP) across prescribers in the national Irish older population using the STOPP criteria; (ii) estimate how reliably the criteria could distinguish between prescribers in terms of their proportion of PIP and; (iii) examine how PIP varies between prescribers and by patient and prescriber characteristics in a multilevel regression model. Methods 1,938 general practitioners (GPs) with 338,375 registered patients’ ≥70 years were extracted from the Health Service Executive Primary Care Reimbursement Service (HSE-PCRS) pharmacy claims database. HSE-PCRS prescriptions are WHO ATC coded. Demographic data for claimants’ and prescribers’ are available. Thirty STOPP indicators were applied to prescription claims in 2007. Multilevel logistic regression examined how PIP varied between prescribers and by individual patient and prescriber level variables. Results The unadjusted variation in PIP between prescribers was considerable (median 35%, IQR 30-40%). The STOPP criteria were reliable measures of PIP (average >0.8 reliability). The multilevel regression models found that only the patient level variable, number of different repeat drug classes was strongly associated with PIP (>2 drugs v none; adjusted OR, 4.0; 95% CI 3.7, 4.3). After adjustment for patient level variables the proportion of PIP varied fourfold (0.5 to 2 times the expected proportion) between prescribers but the majority of this variation was not significant. Conclusion PIP is of concern for all prescribers. Interventions aimed at enhancing appropriateness of prescribing should target patients taking multiple medications.-
dc.language.isoenen
dc.subjectPRESCRIBINGen_GB
dc.subjectOLDER PEOPLEen_GB
dc.titlePrescriber variation in potentially inappropriate prescribing in older populations in Irelanden_GB
dc.typeArticleen
dc.language.rfc3066en-
dc.rights.holderCaitriona Cahir et al.; licensee BioMed Central Ltd.-
dc.description.statusPeer Reviewed-
dc.date.updated2014-04-03T11:06:41Z-
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