title: Inappropriate medication use in the elderly: results from a quality improvement project in 99 primary care practices.
abstract: BACKGROUND
  The use of potentially inappropriate medications (PIMs) in the elderly population is common. Interventions to decrease PIM use in primary care settings are needed.
  
  
  OBJECTIVE
  This study was designed to assess the time trends in use of always inappropriate and rarely appropriate medications in primary care patients aged >or=65 years during a quality improvement project.
  
  
  METHODS
  A 4-year, prospective demonstration project was delivered to 99 primary care practices that use a common electronic medical record and are members of the Practice Partner Research Network. Each participating practice received quarterly performance reports on the use of always inappropriate and rarely appropriate medications in the elderly. Optional interventions included biannual on-site visits and annual network meetings for performance review, academic detailing, and quality improvement planning. General linear mixed regression models were used to analyze the change in prescribing rates over time.
  
  
  RESULTS
  Across 42 months of project exposure, 124,802 active patients (61% women, 39% men) aged >or=65 years were included in the analyses. Among the 33 practices that participated in all 42 months of the intervention, the proportion of patients with a prescription for an always inappropriate medication decreased from 0.41% to 0.33%, and the proportion of patients with a prescription for a rarely appropriate medication decreased from 1.48% to 1.30%. Across all 99 practices, the adjusted absolute annual declines for the comprehensive categories of always inappropriate medications (00.018%, P = 0.03) and rarely appropriate medications (0.113%, P = 0.001) were statistically significant. Propoxyphene was the only individual medication that decreased significantly in use over time (baseline proportion, 0.72%; adjusted absolute annual decline, 0.072% [P = 0.001]).
  
  
  CONCLUSIONS
  Always inappropriate and rarely appropriate medication use decreased over time in this practice-based research network study. Additional studies of robust interventions for improving medication use in the elderly are warranted.
authors.affiliation: Department of Clinical Pharmacy and Outcome Sciences, South Carolina College of Pharmacy, Medical University of South Carolina, Charleston, South Carolina, USA. wessell@musc.edu
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Wessell
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nietert
authors.forename: Ruth G
authors.initials: RG
authors.lastname: Jenkins
authors.forename: Lynne S
authors.initials: LS
authors.lastname: Nemeth
authors.forename: Steven M
authors.initials: SM
authors.lastname: Ornstein
mesh_terms: D000368:Aged; D011307:Drug Prescriptions; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control / Q000639:trends*; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011446:Prospective Studies