title: Potentially inappropriate prescribing and adverse health outcomes in community dwelling older patients.
abstract: OBJECTIVE
  This study aimed to determine the association between potentially inappropriate prescribing (PIP) and health related outcomes [adverse drug events (ADEs), health related quality of life (HRQOL) and hospital accident and emergency (A&E) visits] in older community dwelling patients.
  
  
  METHODS
  A retrospective cohort study of 931 community dwelling patients aged ≥70 years in 15 general practices in Ireland in 2010. PIP was defined by the Screening Tool of Older Person's Prescriptions (STOPP). ADEs were measured by patient self-report and medical record for the previous 6 months and reviewed by two independent clinicians. HRQOL was measured by the EQ-5D. A&E visits were measured by patients' medical records and self-report. Multilevel logistic, linear and Poisson regression examined how ADEs, HRQOL and A&E visits varied by PIP after adjusting for patient and practice level covariates: socioeconomic status, co-morbidity, number of drug classes and adherence.
  
  
  RESULTS
  The overall prevalence of PIP was 42% (n = 377). Patients with ≥2 PIP indicators were twice as likely to have an ADE (adjusted OR 2.21; 95% CI 1.02, 4.83, P < 0.05), have a significantly lower mean HRQOL utility (adjusted coefficient -0.09, SE 0.02, P < 0.001) and nearly a two-fold increased risk in the expected rate of A&E visits (adjusted IRR 1.85; 95% CI 1.32, 2.58, P < 0.001). The number of drug classes and adherence were also significantly associated with these same adverse health outcomes.
  
  
  CONCLUSIONS
  Reducing PIP in primary care may help lower the burden of ADEs, its associated health care use and costs and enhance quality of life in older patients.
authors.affiliation: Department of Pharmacology & Therapeutics, Trinity Centre for Health Sciences, St James Hospital, Dublin, 8.
authors.forename: Caitriona
authors.initials: C
authors.lastname: Cahir
authors.forename: Kathleen
authors.initials: K
authors.lastname: Bennett
authors.forename: Conor
authors.initials: C
authors.lastname: Teljeur
authors.forename: Tom
authors.initials: T
authors.lastname: Fahey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D005260:Female; D006304:Health Status; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D007494:Ireland / Q000453:epidemiology; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D015995:Prevalence; D011788:Quality of Life; D012111:Residence Characteristics
keywords: HRQOL; STOPP; adverse drug events; health care use; older populations; potentially inappropriate prescribing