National trends in and predictors of propoxyphene use in community-dwelling older adults.
BACKGROUND
Several pain management guidelines and explicit medication-use criteria identify propoxyphene as an inappropriate medication for use in older adults.


OBJECTIVE
This study was conducted to estimate trends in propoxyphene use among community-dwelling elderly (age > or = 65 years) Medicare beneficiaries from 1993 through 1999 and to determine whether beneficiaries' drug coverage and specific characteristics of their physicians were associated with receipt of propoxyphene in 1999.


METHODS
Data from the Medicare Current Beneficiary Survey (MCBS) were used to examine the prevalence of propoxyphene use in cross-sections of nationally representative samples of community-dwelling elderly Medicare beneficiaries from 1993 through 1999. The 1999 MCBS was linked with the 1999 Area Resource File to examine patient and physician factors associated with propoxyphene use in the community-dwelling elderly at the county level.


RESULTS
Rates of propoxyphene use were generally stable over the 7-year period, from an annual prevalence of 6.8% in 1993 to the slightly decreased prevalence of 6.6% in 1999. No protective effects against propoxyphene use were observed based on beneficiaries' drug coverage or type of drug coverage. Rather, Medicaid beneficiaries were more likely to receive propoxyphene than those without drug coverage (odds ratio [OR] = 1.40; 95% CI, 1.02-1.92). Among physician characteristics, male sex (OR = 1.34; 95% CI, 1.02-1.75) and medical specialty (OR = 0.81; 95% CI, 0.65-1.00) were strongly correlated with prescribing of propoxyphene.


CONCLUSIONS
This study found a continuing high prevalence of propoxyphene use in the community-dwelling elderly Medicare population from 1993 through 1999, with > 2 million beneficiaries receiving the drug in 1999.
Kamal-Bahl
Sachin
S
Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, Maryland, USA. sachin_kamal_bahl@merck.com
Stuart
Bruce C
BC
Beers
Mark H
MH
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D002908:Chronic Disease; D011431:Dextropropoxyphene / Q000600:supply & distribution / Q000627:therapeutic use*; D004363:Drug Utilization / Q000639:trends; D017723:Drug Utilization Review; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D006278:Medicare; D008511:Medicine / Q000639:trends; D011379:Prognosis; D012111:Residence Characteristics; D012424:Rural Population / Q000706:statistics & numerical data; D012737:Sex Factors; D013038:Specialization; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data
D000701:Analgesics, Opioid; D011431:Dextropropoxyphene