Potentially inappropriate prescriptions for older patients in long-term care.
BACKGROUND
Inappropriate medication use is a major healthcare issue for the elderly population. This study explored the prevalence of potentially inappropriate prescriptions (PIPs) in long-term care in metropolitan Quebec.


METHODS
A cross sectional chart review of 2,633 long-term care older patients of the Quebec City area was performed. An explicit criteria list for PIPs was developed based on the literature and validated by a modified Delphi method. Medication orders were reviewed to describe prescribing patterns and to determine the prevalence of PIPs. A multivariate analysis was performed to identify predictors of PIPs.


RESULTS
Almost all residents (94.0%) were receiving one or more prescribed medication; on average patients had 4.8 prescribed medications. A majority (54.7%) of treated patients had a potentially inappropriate prescription (PIP). Most common PIPs were drug interactions (33.9% of treated patients), followed by potentially inappropriate duration (23.6%), potentially inappropriate medication (14.7%) and potentially inappropriate dosage (9.6%). PIPs were most frequent for medications of the central nervous system (10.8% of prescribed medication). The likelihood of PIP increased significantly as the number of drugs prescribed increased (odds ratio [OR]: 1.38, 95% confidence interval [CI]: 1.33-1.43) and with the length of stay (OR: 1.78, CI: 1.43-2.20). On the other hand, the risk of receiving a PIP decreased with age.


CONCLUSIONS
Potentially inappropriate prescribing is a serious problem in the highly medicated long-term care population in metropolitan Quebec. Use of explicit criteria lists may help identify the most critical issues and prioritize interventions to improve quality of care and patient safety.
Health Economics and Outcomes Research, Merck Frosst Canada Ltd, Montreal, Qc, H9H 3L1, Canada. carol_rancourt@merck.com
Carol
C
Rancourt
Jocelyne
J
Moisan
Lucie
L
Baillargeon
René
R
Verreault
Danielle
D
Laurin
Jean-Pierre
JP
Grégoire