Inappropriate medication prescribing for the elderly by office-based physicians.
OBJECTIVE
To estimate the prevalence of inappropriate medications prescribed by office-based physicians for patients 65 years or older.


METHODS
A nationwide cross-sectional survey of office visits by the elderly.


METHODS
The National Ambulatory Medical Care Survey (NAMCS) 1992, a national probability sample survey of office visits by ambulatory patients within the continental US.


METHODS
A national probability sample of patients 65 years or older visiting office-based physicians. National estimates are based on the National Center for Health Statistics weighting procedure for the NAMCS sample.


METHODS
Prevalence of 20 inappropriate medications that should be entirely avoided in the elderly, using criteria developed by a panel of national experts in geriatric medicine and geriatric pharmacology.


RESULTS
In the US during 1992, an estimated 8.47 million (95% CI 7.66 million to 9.28 million) office visits by the elderly indicated prescribing of at least 1 of the 20 inappropriate medications. Approximately 7.75 million (95% CI 6.98 million to 8.52 million) visits by the elderly involved 1 inappropriate medication and 0.72 million (95% CI 0.51 million to 0.93 million) visits included 2 inappropriate medications. According to the NAMCS, office-based physicians prescribed at least 1 inappropriate medication to 7.58% of the elderly who received prescriptions. The most frequently prescribed inappropriate medications were propoxyphene, amitriptyline, dipyridamole, diazepam, and chlorpropamide. Elderly patients rarely received prescriptions from office-based physicians for drugs such as secobarbital, isoxsuprine, trimethobenzamide, and carisoprodol. Furthermore, office-based physicians did not prescribe cyclandelate, pentobarbital, or phenylbutazone for the elderly.


CONCLUSIONS
The prescribing of inappropriate medications by office-based physicians raises concerns regarding the quality of care for the elderly in ambulatory settings. The crux of improving patient care in ambulatory settings rests with collaborative efforts between physicians and pharmacists.
Aparasu
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RR
College of Pharmacy, South Dakota State University, Brookings 57007 USA. aparasur@mg.sdstate.edu
Fliginger
S E
SE
D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000592:standards*; D000075202:Contraindications; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions; D004358:Drug Therapy / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D011788:Quality of Life; D018709:Statistics, Nonparametric; D014481:United States