Propoxyphene use by community-dwelling and institutionalized elderly Medicare beneficiaries.
OBJECTIVE
To provide the first comparable national prevalence estimates on use of propoxyphene, a potentially inappropriate drug, by elderly Medicare beneficiaries living in the community and institutions and to determine whether institutionalized beneficiaries are at a greater risk for receiving propoxyphene than community-dwelling beneficiaries.


METHODS
Cross-sectional study.


METHODS
U.S. representative sample of elderly using Medicare database.


METHODS
Nationally representative sample of community-dwelling (n = 9,851, weighted n = 32.5 million) and institutionalized (n = 1,099, weighted n = 2.3 million) Medicare beneficiaries aged 65 and older.


METHODS
National estimates on prevalence of propoxyphene use and the odds of receiving propoxyphene were the two main outcome measures.


RESULTS
Annual prevalence of propoxyphene use in 1998 was 6.8% by all community-dwelling elderly beneficiaries and 15.5% by institutionalized elderly beneficiaries. Beneficiaries in long-term care facilities had almost 40% higher odds of receiving propoxyphene (odds ratio = 1.38, 95% confidence interval = 1.1-1.8) than beneficiaries in the community even after controlling for other factors in a logistic regression. Other risk factors include female, rural residence, poor health, and history of osteoporosis or hip fracture. Beneficiaries residing in regions in the midwest and south were more than twice as likely to receive propoxyphene as those in the mid-Atlantic area.


CONCLUSIONS
These results show that propoxyphene use by U.S. community-dwelling seniors is high but is much higher in the institutionalized population. These findings suggest that prescribing for older adults with pain could be improved, especially for vulnerable long-term care residents.
Kamal-Bahl
Sachin J
SJ
University of Maryland Baltimore, School of Pharmacy, Maryland 21201, USA. skama001@umaryland.edu
Doshi
Jalpa A
JA
Stuart
Bruce C
BC
Briesacher
Becky A
BA
D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D011431:Dextropropoxyphene / Q000627:therapeutic use*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D014481:United States
D000701:Analgesics, Opioid; D011431:Dextropropoxyphene