Prescribing potentially inappropriate psychotropic medications to the ambulatory elderly.
BACKGROUND
Psychotropic agents account for 23% to 51% of all inappropriate medications prescribed based on 1991 inappropriate medication criteria for nursing home residents. The criteria were revised to apply to all people older than 65 years. This study used the revised criteria in ambulatory settings to quantify potentially inappropriate prescription of psychotropic agents and identify associated characteristics.


METHODS
The 1996 public use data files of the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey were analyzed for inappropriate prescription of psychotropic medications for the elderly in office-based settings and outpatient departments. Disease-independent and disease-dependent criteria were analyzed.


RESULTS
Elderly patients were prescribed a psychotropic agent in 8. 7% of all visits, antidepressant and antianxiety agents being the most frequently prescribed medications. Commonly, elderly patients receiving psychotropic agents were female, white, aged between 65 and 74 years, and received health care in a metropolitan area. Potentially inappropriate psychotropic agents were prescribed in 27. 2% of all visits involving a psychotropic agent for the elderly. Disease-independent criteria (eg, antidepressant agents and long-acting benzodiazepines) accounted for most of the potentially inappropriate prescriptions. Factors positively associated with potentially inappropriate prescriptions included older age, "seen before" status, and antidepressant drug class, while enrollment in Medicaid, antipsychotic drug class, living in the Northeast region, and receiving health care in a metropolitan area were negatively associated.


CONCLUSIONS
Potentially inappropriate prescription of psychotropic agents is very common for the elderly patient in the ambulatory setting. By focusing on the agents most frequently involved (eg, amitriptyline and long-acting benzodiazepines), provider characteristics (eg, location), and patient characteristics (eg, age), the greatest impact on potentially inappropriate prescribing can be achieved.
Mort
J R
JR
College of Pharmacy-South Dakota State University, 1011 11th St, Rapid City, SD 57701, USA. Jane_Mort@sdstate.edu
Aparasu
R R
RR
D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D000553:Ambulatory Care; D000639:Amitriptyline / Q000009:adverse effects / Q000627:therapeutic use; D014151:Anti-Anxiety Agents / Q000009:adverse effects / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D001569:Benzodiazepines; D004363:Drug Utilization; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D011619:Psychotropic Drugs / Q000009:adverse effects* / Q000627:therapeutic use; D012307:Risk Factors; D014481:United States
D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D011619:Psychotropic Drugs; D001569:Benzodiazepines; D000639:Amitriptyline