Potentially inappropriate medication use in hospitalized elders.
BACKGROUND
Prescribing of potentially harmful medications has not been well documented in hospitals.


OBJECTIVE
The objective of the study was to determine the rate of and factors associated with potentially inappropriate medication (PIM) prescribing in a large inpatient sample.


METHODS
The study was a retrospective cohort of the period between September 1, 2002, and June 30, 2005. We used multivariable logistic regression to identify patient, physician, and hospital characteristics associated with PIM prescribing.


METHODS
The study collected data from 384 US hospitals.


METHODS
The sample was composed of patients aged >or=65 years admitted with 1 or more of 7 common medical diagnoses.


METHODS
The percentage of patients prescribed PIMs as defined using a modified Beers list was measured. Multivariable-adjusted odds ratios for PIM use were computed.


RESULTS
Of the 493,971 patients, 49% received at least 1 PIM, and 6% received 3 or more, most commonly promethazine, diphenhydramine, and propoxyphene. Patient, physician, and hospital characteristics were all associated with PIM use. Patients with myocardial infarction or heart failure were most likely (61% and 52% vs. 46% for pneumonia), men (47% vs. 49% for women) and those in managed care plans (44% vs. 49% for other plans) were less likely, and patients >or=85 years were least likely (42% vs. 53% for patients aged 65-74 years) to receive PIMs (P < .0001 for all comparisons). For high-severity PIMs, internists and hospitalists had similar prescribing rates (33%), cardiologists had a higher rate (48%), and geriatricians had the lowest rate (24%). The proportion of elders receiving PIMs ranged from 34% in the Northeast to 55% in the South, and variation at the individual hospital level was extreme. At 7 hospitals, PIMs were never prescribed.


CONCLUSIONS
Wide variation in the use of PIMs is associated with hospital and physician characteristics. Care may be improved by minimizing this non-patient-centered variation.
Rothberg
Michael B
MB
Division of General Medicine and Geriatrics, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts 01199, USA. Michael.Rothberg@bhs.org
Pekow
Penelope S
PS
Liu
Fengjuan
F
Korc-Grodzicki
Beatriz
B
Brennan
Maura J
MJ
Bellantonio
Sandra
S
Heelon
Mark
M
Lindenauer
Peter K
PK
D000368:Aged; D000369:Aged, 80 and over; D002309:Cardiology / Q000706:statistics & numerical data; D015331:Cohort Studies; D000075202:Contraindications; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000592:standards* / Q000706:statistics & numerical data; D017723:Drug Utilization Review / Q000379:methods*; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005853:Geriatrics / Q000706:statistics & numerical data*; D020445:Hospitalists / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients; D016015:Logistic Models; D008297:Male; D004364:Pharmaceutical Preparations; D017891:Pharmacoepidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States
D004364:Pharmaceutical Preparations