title: Potentially inappropriate prescribing in elderly: assessing doctor knowledge, confidence and barriers.
abstract: BACKGROUND
  Inappropriate medication prescribing by doctors is an important preventable cause of morbidity and mortality in the elderly. This study investigates doctor knowledge about potentially inappropriate prescribing (PIP) in elderly, their confidence in prescribing for the elderly and explores perceived barriers.
  
  
  METHODS
  Family and Internal Medicine resident and attending doctors at three teaching hospitals were asked to complete a survey. Six clinical vignettes based on the 2003 Beers criteria were used to evaluate doctor knowledge about medications to avoid in the elderly. Confidence in prescribing for the elderly and perceived barriers to appropriate prescribing in elderly was assessed using a 5-point Likert scale.
  
  
  RESULTS
  Eighty-nine doctors completed the survey, for a response rate of 45%. Forty-four per cent of surveyed doctors estimated that over 25% of their practice consisted of patients 65 years or older. When knowledge of PIP was assessed via vignettes, the mean correct response was 3.9 (SD: 1.1, min = 1, max = 6). Only 14% of those doctors scoring ≤4 vignettes correctly had used the Beers criteria for prescribing; 31% of the doctors answering ≥5 vignettes correctly had used the Beers criteria (P = 0.08). Overall, 75% of doctors felt confident about their prescribing irrespective of their knowledge scores. Seventy per cent of surveyed doctors cited at least seven different barriers to appropriate prescribing in elderly.
  
  
  CONCLUSIONS
  Many primary care doctors possess a poor knowledge of PIP and are unaware of prescribing guidelines such as the Beers criteria. Our survey indicates that doctor usage of the Beers criteria might correlate with improved judgement in prescribing for the elderly. Most doctors report multiple barriers to appropriate prescribing in the elderly. Lack of formal education about prescribing guidelines was the only barrier that correlated with the doctors' level of training.
authors.affiliation: Underwood-Memorial Hospital, Woodbury, New Jersey, USA. ravishankar.ramaswamy@gmail.com
authors.forename: Ravishankar
authors.initials: R
authors.lastname: Ramaswamy
authors.forename: Vittorio
authors.initials: V
authors.lastname: Maio
authors.forename: James J
authors.initials: JJ
authors.lastname: Diamond
authors.forename: Amy R
authors.initials: AR
authors.lastname: Talati
authors.forename: Christine W
authors.initials: CW
authors.lastname: Hartmann
authors.forename: Christine
authors.initials: C
authors.lastname: Arenson
authors.forename: Barbara
authors.initials: B
authors.lastname: Roehl
mesh_terms: D000368:Aged; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization; D019983:Guideline Adherence / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D057970:Inappropriate Prescribing / Q000523:psychology* / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*