title: Beers criteria as a proxy for inappropriate prescribing of other medications among older adults.
abstract: BACKGROUND
  The Beers criteria are a compilation of medications deemed potentially inappropriate for older adults, widely used as a prescribing quality indicator.
  
  
  OBJECTIVE
  To determine whether Beers criteria serve as a proxy measure for other forms of inappropriate prescribing, as measured by comprehensive implicit review.
  
  
  METHODS
  Data for patients 65 years and older were obtained from the Veterans Affairs Enhanced Pharmacy Outpatient Clinic (EPOC) and the Iowa Medicaid Pharmaceutical Case Management (PCM) studies. Comprehensive measurement of prescribing quality was conducted using expert clinician review of medical records according to the Medication Appropriateness Index (MAI). MAI scores attributable to non-Beers medications were contrasted between patients who did and did not receive a Beers criteria medication.
  
  
  RESULTS
  Beers criteria medications accounted for 12.9% (EPOC) and 14.0% (PCM) of total MAI scores. Importantly, non-Beers MAI scores were significantly higher in patients receiving a Beers criteria medication in both studies (EPOC: 15.1 vs 12.4, p = 0.02; PCM: 11.1 vs 8.7, p = 0.04), after adjusting for important confounding factors.
  
  
  CONCLUSIONS
  Beers criteria utility extended beyond direct measurement of a limited set of inappropriate prescribing practices by serving as a clinically meaningful proxy for other inappropriate practices. Using prescribing quality indicators to guide interventions should thus identify patients for comprehensive medication review, rather than identifying specific medication targets for discontinuation. Future research should explore both the quality measurement and the intervention targeting applications of the Beers criteria, particularly when integrated with other indicators.
authors.affiliation: Center for Comprehensive Access and Delivery Research and Evaluation, Veterans Affairs Iowa City Health Care System, Iowa City, IA, USA. Brian.Lund@va.gov
authors.forename: Brian C
authors.initials: BC
authors.lastname: Lund
authors.forename: Michael A
authors.initials: MA
authors.lastname: Steinman
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Chrischilles
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kaboli
mesh_terms: D000367:Age Factors; D000368:Aged; D003299:Cooperative Behavior; D011307:Drug Prescriptions / Q000592:standards*; D017723:Drug Utilization Review / Q000592:standards; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000009:adverse effects / Q000517:prevention & control*; D007484:Iowa; D008297:Male; D008499:Medical Records / Q000592:standards; D008508:Medication Errors / Q000009:adverse effects / Q000517:prevention & control*; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D010595:Pharmacists / Q000592:standards; D019338:Polypharmacy; D019727:Proxy
chemical_list: D004364:Pharmaceutical Preparations