title: Potentially inappropriate prescribing for the elderly: effects of geriatric care at the patient and health care system level.
abstract: BACKGROUND
  Many studies have identified patient characteristics associated with potentially inappropriate prescribing in the elderly (PIPE), however, little attention has been directed toward how health care system factors such as geriatric care may affect this patient safety issue.
  
  
  OBJECTIVE
  This study examines the association between geriatric care and PIPE in a community dwelling elderly population.
  
  
  METHODS
  Cross-sectional retrospective database study.
  
  
  METHODS
  Veterans age > or =65 years who received health care in the VA system during Fiscal Years (FY99-00), and also received at medications from the Veterans Administration in FY00.
  
  
  METHODS
  PIPE was identified using the Zhan adaptation of the Beers criteria. Geriatric care penetration was calculated as the proportion of patients within a facility who received at least 1 geriatric outpatient clinic or inpatient visit.
  
  
  METHODS
  Logistic regression models with generalized estimating equations were used to assess the relationship between geriatric care and PIPE after controlling for patient and health care system characteristics.
  
  
  RESULTS
  Patients receiving geriatric care were less likely to have PIPE exposure (odds ratio, 0.64; 95% confidence interval, 0.59-0.73). There was also a weak effect for geriatric care penetration, with a trend for patients in low geriatric care penetration facilities having higher risk for PIPE regardless of individual geriatric care exposure (odds ratio, 1.14; 95% confidence interval, 0.99-1.30).
  
  
  CONCLUSIONS
  Although geriatric care is associated with a lower risk of PIPE, additional research is needed to determine if heterogeneity in the organization and delivery of geriatric care resulted in the weak effect of geriatric care penetration, or whether this is a result of low power.
authors.affiliation: South Texas Veterans Health Care System, San Antonio, Texas, USA. pughm@uthscsa.edu
authors.forename: Mary Jo V
authors.initials: MJ
authors.lastname: Pugh
authors.forename: Amy K
authors.initials: AK
authors.lastname: Rosen
authors.forename: Maria
authors.initials: M
authors.lastname: Montez-Rath
authors.forename: Megan E
authors.initials: ME
authors.lastname: Amuan
authors.forename: Benjamin G
authors.initials: BG
authors.lastname: Fincke
authors.forename: Muriel
authors.initials: M
authors.lastname: Burk
authors.forename: Arlene
authors.initials: A
authors.lastname: Bierman
authors.forename: Francesca
authors.initials: F
authors.lastname: Cunningham
authors.forename: Eric M
authors.initials: EM
authors.lastname: Mortensen
authors.forename: Dan R
authors.initials: DR
authors.lastname: Berlowitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000592:standards; D003430:Cross-Sectional Studies; D004059:Diffusion of Innovation; D004358:Drug Therapy / Q000592:standards*; D017723:Drug Utilization Review; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005853:Geriatrics / Q000592:standards*; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006299:Health Services for the Aged / Q000592:standards*; D006787:Hospitals, Veterans / Q000592:standards; D006801:Humans; D016015:Logistic Models; D008297:Male; D008508:Medication Errors; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data