title: Potentially inappropriate prescribing in elderly veterans: are we using the wrong drug, wrong dose, or wrong duration?
abstract: OBJECTIVE
  To identify the extent of inappropriate prescribing using criteria for proper use developed by the Agency for Healthcare Research and Quality (AHRQ) and dose-limitation criteria defined by Beers, as well as to describe duration of use and patient characteristics associated with inappropriate prescribing for older people.
  
  
  METHODS
  Retrospective national Veterans Health Administration (VA) administrative database analysis.
  
  
  METHODS
  VA outpatient facilities during fiscal year 2000 (FY00).
  
  
  METHODS
  Veterans aged 65 and older having at least one VA outpatient visit in FY00 (N=1,265,434).
  
  
  METHODS
  Operational definitions of appropriate use were developed based on recommendations of an expert panel convened by the AHRQ (Zhan criteria). Inappropriate use was identified based on these criteria and inappropriate use of drugs per Beers criteria for dose-limitations in older people. Furthermore, duration of use and patient characteristics associated with inappropriate use were described.
  
  
  RESULTS
  After adjusting for diagnoses, dose, and duration, inappropriate prescribing decreased from 33% to 23%. Exposure to inappropriate drugs was prolonged. Pain relievers, benzodiazepines, antidepressants, and musculoskeletal agents constituted 61% of inappropriate prescribing. Whites, patients with psychiatric comorbidities, and patients receiving more medications were most likely to receive inappropriate drugs. Women were more likely to receive Zhan criteria drugs; men were more likely to receive dose-limited drugs
  
  
  CONCLUSIONS
  For the most part, the Zhan criteria did not explain inappropriate prescribing, which includes problems related to dose and duration of prescriptions. Interventions targeted at prescriptions for pain relievers, benzodiazepines, antidepressants, and musculoskeletal agents may dramatically decrease inappropriate prescribing and improve patient outcomes.
authors.affiliation: Veterans Evidence-based Research Dissemination and Implementation Center, Audie L. Murphy Division /South Texas Veterans Health Care System, San Antonio, Texas 78229, USA. pughm@uthscsa.edu
authors.forename: Mary Jo V
authors.initials: MJ
authors.lastname: Pugh
authors.forename: B Graeme
authors.initials: BG
authors.lastname: Fincke
authors.forename: Arlene S
authors.initials: AS
authors.lastname: Bierman
authors.forename: Bei-Hung
authors.initials: BH
authors.lastname: Chang
authors.forename: Amy K
authors.initials: AK
authors.lastname: Rosen
authors.forename: Francesca E
authors.initials: FE
authors.lastname: Cunningham
authors.forename: Megan E
authors.initials: ME
authors.lastname: Amuan
authors.forename: Muriel L
authors.initials: ML
authors.lastname: Burk
authors.forename: Dan R
authors.initials: DR
authors.lastname: Berlowitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D011307:Drug Prescriptions / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014481:United States; D014728:Veterans