title: National outpatient medication profiling: medications associated with outpatient fractures in community-dwelling elderly veterans.
abstract: OBJECTIVE
  The primary objective of this retrospective case-control study in an elderly veteran population was to assess the impact of specific medications with recognized side-effects that increase the risk of a fall and were prescribed prior to fractures treated in the outpatient setting compared with patients treated for nonspecific chest pain.
  
  
  METHODS
  Two national Veterans Health Administration (VHA) databases were used to identify 17 273 unique patients, aged > or =65 years, treated in outpatient settings with a fracture in fiscal year 2005, and for whom we could link to all of their outpatient prescriptions (809 536). For comparison, we identified other elderly patients with outpatient clinic visits for nonspecific chest pain (N = 62 331) for whom we could link with their 2 987 394 outpatient prescriptions. We categorized the fall-related medications as drugs that primarily affect the cardiovascular (CVS), the central nervous (CNS) or the muscular skeletal system (MSS).
  
  
  RESULTS
  Significant differences in the two patient groups occurred in the CNS category. Approximately 41% of the patients with fracture-coded encounters were prescribed CNS drugs compared with 31% of the patients in the comparison group (P < 0.0003). Finally, the use of muscle relaxants in the MSS category was significantly higher in the fracture group than in the nonspecific chest pain group.
  
  
  CONCLUSIONS
  Studies using administrative data can foster the development of more proactive pharmacovigilance systems and assist in formulary refinement, particularly in countries with national healthcare systems that have integrated patient data. Particular attention and monitoring of elderly patients taking CNS medications may be important for injury prevention.
authors.affiliation: VISN-8 Patient Safety Center of Inquiry, James A. Haley Hospital, Tampa, FL 33612, USA. Dustin.French@va.gov
authors.forename: Dustin D
authors.initials: DD
authors.lastname: French
authors.forename: Robert
authors.initials: R
authors.lastname: Campbell
authors.forename: Andrea
authors.initials: A
authors.lastname: Spehar
authors.forename: Laurence Z
authors.initials: LZ
authors.lastname: Rubenstein
authors.forename: Laurence G
authors.initials: LG
authors.lastname: Branch
authors.forename: Francesca
authors.initials: F
authors.lastname: Cunningham
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D016022:Case-Control Studies; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D050723:Fractures, Bone / Q000139:chemically induced*; D006801:Humans; D008297:Male; D004364:Pharmaceutical Preparations / Q000191:economics; D012189:Retrospective Studies; D012307:Risk Factors; D014728:Veterans
chemical_list: D004364:Pharmaceutical Preparations