Underreporting Potentially Inappropriate Prescribing for Older Outpatients: Does It Matter?
Authors: Matthew L. Maciejewski, Joseph T. Hanlon
Journal: Annals of Internal Medicine (2013)

EditorialsOctober 1, 2013Underreporting Potentially Inappropriate Prescribing for Older Outpatients: Does It Matter?Matthew L. Maciejewski, PhD and Joseph T. Hanlon, PharmD, MSMatthew L. Maciejewski, PhDFrom Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, and School of Medicine, Duke University Medical Center, Durham, North Carolina; and School of Medicine, University of Pittsburgh, and Center for Health Equity Research and Promotion and Geriatric Research, Education, and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.Search for more papers by this author and Joseph T. Hanlon, PharmD, MSFrom Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, and School of Medicine, Duke University Medical Center, Durham, North Carolina; and School of Medicine, University of Pittsburgh, and Center for Health Equity Research and Promotion and Geriatric Research, Education, and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-159-7-201310010-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Many older adults have multiple chronic conditions that often require several drugs to prevent or treat symptoms and to maintain functional status (1). Suboptimal prescribing makes these patient-centered goals difficult to achieve. Although some believe that under- or overprescribing is the most common type of suboptimal prescribing, occurring in up to 50% of older adults, evidence suggests that up to 92% of older adults receive 1 or more inappropriate medications (2, 3). Of concern is that inappropriate prescribing increases the risk for negative health outcomes, such as adverse drug reactions and increased use of health services (1, 3).In 2006, ...References1. Hanlon JT, Handler S, Maher R, and Schmader KE. Geriatric pharmacotherapy and polypharmacy.. In: Fillit HM, Rockwood K, Woodhouse K, eds. Brocklehurst's Textbook of Geriatric Medicine. 7th ed. London Churchill Livingstone 2010 880-5. Google Scholar2. O'Connor MN, Gallagher P, and O'Mahony D. Inappropriate prescribing: criteria, detection and prevention. Drugs Aging. 2012;29:437-52. [PMID: 22642779] CrossrefMedlineGoogle Scholar3. Spinewine A, Schmader KE, Barber N, Hughes C, Lapane KL, Swine C, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet. 2007;370:173-84. [PMID: 17630041] CrossrefMedlineGoogle Scholar4. Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, and Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163:2716-24. [PMID: 14662625] CrossrefMedlineGoogle Scholar5. Pugh MJ, Hanlon JT, Wang CP, Semla T, Burk M, Amuan ME, et al. Trends in use of high-risk medications for older veterans: 2004 to 2006. J Am Geriatr Soc. 2011;59:1891-8. [PMID: 21883108] CrossrefMedlineGoogle Scholar6. Cooper AL, Kazis LE, Dore DD, Mor V, and Trivedi AN. Underreporting high-risk prescribing among Medicare Advantage plans. A cross-sectional analysis. Ann Intern Med. 2013;159:456-62. LinkGoogle Scholar7. Pugh MJ, Marcum ZA, Copeland LA, Mortensen EM, Zeber JE, Noël PH, et al. The quality of quality measures: HEDIS quality measures for medication management in the elderly and outcomes associated with new exposure. Drugs Aging. 2013;30:645-54. [PMID: 23645530] CrossrefMedlineGoogle Scholar8. American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60:616-31. [PMID: 22376048] CrossrefMedlineGoogle Scholar9. Gnjidic D and Johnell K. Clinical implications from drug-drug and drug-disease interactions in older people. Clin Exp Pharmacol Physiol. 2013;40:320-5. [PMID: 23528015] CrossrefMedlineGoogle Scholar10. Gallagher P and O'Mahony D. STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers' criteria. Age Ageing. 2008;37:673-9. [PMID: 18829684] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, and School of Medicine, Duke University Medical Center, Durham, North Carolina; and School of Medicine, University of Pittsburgh, and Center for Health Equity Research and Promotion and Geriatric Research, Education, and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-1979.Corresponding Author: Matthew L. Maciejewski, PhD, Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Mailstop 152, Durham, NC 27705.Current Author Addresses: Dr. Maciejewski: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street, Mailstop 152, Durham, NC 27705.Dr. Hanlon: University of Pittsburgh, 3471 Fifth Avenue, Kaufman Building, Suite 500, Pittsburgh, PA 15213. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoUnderreporting High-Risk Prescribing Among Medicare Advantage Plans Alicia L. Cooper , Lewis E. Kazis , David D. Dore , Vincent Mor , and Amal N. Trivedi Metrics October 1, 2013Volume 159, Issue 7Page: 496-497KeywordsAdverse reactionsBeerChronic kidney diseaseDementiaDrug interactionsDrugsElderlyFallsGeriatricsHealth care quality assessmentHip fracturesHospitalizationsMedical servicesMedicareOutpatients ePublished: 1 October 2013 Issue Published: October 1, 2013 PDF downloadLoading ...