Drugs & Aging

, Volume 25, Issue 8, pp 693–706 | Cite as

What Factors Predict Potentially Inappropriate Primary Care Prescribing in Older People?

Analysis of UK Primary Care Patient Record Database
  • Iain M. Carey
  • Stephen De Wilde
  • Tess Harris
  • Christina Victor
  • Nicky Richards
  • Sean R. Hilton
  • Derek G. Cook
Original Research Article

Abstract

Background

Potentially inappropriate prescribing (PIP) in older people has been identified as a substantial problem, but few large population-based studies have investigated the underlying factors that predict it.

Objective

To: (i) examine trends in PIP in UK older primary care patients; and (ii) assess factors associated with PIP.

Methods

An analysis of routine, anonymized, computerized patient records of 201 UK general practices providing data to the DIN-LINK database between 1996 and 2005, which included approximately 230 000 registered patients per year aged ≥65 years. The main outcome measures were the number of different drugs prescribed per patient annually and the percentage of patients prescribed a PIP drug (modified 2003 Beers criteria). These were assessed for all drugs, and then for selected sub-classes (analgesics, antidepressants and sedatives/anxiolytics).

Results

Whilst the number of drugs prescribed per patient increased, the percentage of subjects receiving a PIP drug declined from 32.2% in 1996 to 28.3% in 2005, largely due to a fall in co-proxamol (dextropropoxyphene/paracetamol [acetaminophen]) prescribing. In 2005, female gender, being older, more socioeconomically deprived or in a care home were strongly associated with PIP. However, the number of drugs prescribed was strongly associated with these variables and the strongest predictor of PIP; adjusting for number of drugs dramatically reduced the strength of all other associations except female gender with PIP. Factors predicting PIP in drug sub-groups were similarly reduced when adjusted for polypharmacy. However, some age trends remained: in the oldest group (aged ≥85 years), PIP of analgesics was less likely (odds ratio [OR] = 0.70, 95% CI 0.66, 0.75) while PIP of antidepressants was more likely (OR =1.39, 95% CI 1.28, 1.51).

Conclusion

PIP amongst older people in the UK, although declining, remains at a high level. The association of PIP with age, deprivation and care homes is largely explained by the higher overall prescribing rates in these groups. The overall rise in prescribing emphasizes that polypharmacy does not necessarily increase PIP and attempts to reduce PIP by focusing on polypharmacy have not been successful. Reductions in PIP have previously been achieved by introducing national guidelines (e.g. co-proxamol), but might also be achieved by alerting practitioners at the point of prescribing.

Keywords

Care Home Doxazosin Read Code Potentially Inappropriate Prescribe Outcome Framework 

Notes

Acknowledgements

This study was funded by the Bupa Foundation.

Nicky Richards is a former director of Cegedim Strategic Data, which markets DIN-LINK data to pharmaceutical companies. The other authors have no conflicts of interest that are directly relevant to the content of this article.

This study was approved by the National Health Service Research Ethics Committee for Wandsworth (reference 05/Q0803/162).

Supplementary material

40266_2012_25080693_MOESM1_ESM.pdf (110 kb)
Supplementary material, approximately 113 KB.

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Copyright information

© Adis Data Information BV 2008

Authors and Affiliations

  • Iain M. Carey
    • 1
  • Stephen De Wilde
    • 1
  • Tess Harris
    • 1
  • Christina Victor
    • 2
  • Nicky Richards
    • 3
  • Sean R. Hilton
    • 1
  • Derek G. Cook
    • 1
  1. 1.Division of Community Health Sciences, St George’sUniversity of LondonUK
  2. 2.University of ReadingReading, BerkshireUK
  3. 3.Cegedim Strategic Data UK LtdChertsey, SurreyUK

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