Potentially inappropriate medication utilization in the emergency department visits by older adults: analysis from a nationally representative sample.
OBJECTIVE
The objectives were to determine the frequency of administration of potentially inappropriate medications (PIMs) to older emergency department (ED) patients and to examine recent trends in the rates of PIM usage.


METHODS
The data examined during the study were obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS). This study utilized the nationally representative ED data from 2000-2006 NHAMCS surveys. Our sample included older adults (age 65 years and greater) who were treated in the ED and discharged home. Estimated frequencies of PIM-associated ED visits were calculated. A multivariable logistic regression model was created to assess demographic, clinical, and hospital factors associated with PIM administration and to assess temporal trends.


RESULTS
Approximately 19.5 million patients, or 16.8% (95% confidence interval [CI]=16.1% to 17.4%) of eligible ED visits, were associated with one or more PIMs. The five most common PIMs were promethazine, ketorolac, propoxyphene, meperidine, and diphenhydramine. The total number of medications prescribed or administered during the ED visit was most strongly associated with PIM use. Other covariates associated with PIM use included rural location outside of the Northeast, being seen by a staff physician only (and not by a resident or intern), presenting with an injury, and the combination of female sex and age 65-74 years. There was a small but significant decrease in the proportion of visits associated with a PIM over the study period.


CONCLUSIONS
Potentially inappropriate medication administration in the ED remains common. Given rising concerns about preventable complications of medical care, this area may be of high priority for intervention. Substantial regional and hospital type (teaching versus nonteaching) variability appears to exist.
Meurer
William J
WJ
Department of Emergency Medicine, the University of Michigan Medical School, and the Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, USA. wmeurer@med.umich.edu
Potti
Tommy A
TA
Kerber
Kevin A
KA
Sasson
Comilla
C
Macy
Michelle L
ML
West
Brady T
BT
Losman
Eve D
ED
D000368:Aged / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D004358:Drug Therapy / Q000706:statistics & numerical data*; D004635:Emergency Medicine / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000706:statistics & numerical data; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D017751:Safety Management; D014481:United States; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*