title: High prevalence of poor quality drug prescribing in older individuals: a nationwide report from the Italian Medicines Agency (AIFA).
abstract: BACKGROUND
  Poor quality of drug prescribing in older persons is often associated with increased drug-related adverse events, hospitalization, and mortality. The present study describes a set of prescribing quality indicators developed by the Geriatrics Working Group of the Italian Medicines Agency (AIFA) and estimates their prevalence in the entire elderly (≥ 65 years) population in Italy.
  
  
  METHODS
  We performed a cross-sectional study using 2011 data from the OsMed (Osservatorio dei Medicinali) database, which comprises all prescribed drugs that are reimbursed by the Italian National Healthcare System. Yearly prevalence of drug prescribing quality indicators in the Italian older population (n = 12,301,537) was determined.
  
  
  RESULTS
  Overall, 13 quality indicators addressing polypharmacy, adherence to treatment of chronic diseases, prescribing cascade, undertreatment, drug-drug interactions, and drugs to be avoided were identified. Polypharmacy was common, with more than 1.3 million individuals taking greater than or equal to 10 drugs (11.3% of the study population). The prevalence of low adherence and undertreatment was also elevated and increased with advancing age, with highest prevalence occurring in individuals aged 85 years and older. Prevalence was less than 3% for quality indicators assessing the prescribing cascade, drug-drug interactions, and drugs to be avoided.
  
  
  CONCLUSIONS
  These results confirm the high frequency of suboptimal drug prescribing in older adults, using a database that covers the whole Italian population. In general, this descriptive study may help in prioritizing strategies aimed at improving the quality of prescribing in elderly population.
authors.affiliation: Centro Medicina dell'Invecchiamento, Dipartimento di Scienze Gerontologiche, Geriatriche e Fisiatriche, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Roma, Italy. graziano_onder@rm.unicatt.it.
authors.forename: Graziano
authors.initials: G
authors.lastname: Onder
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonassi
authors.forename: Angela M
authors.initials: AM
authors.lastname: Abbatecola
authors.forename: Pietro
authors.initials: P
authors.lastname: Folino-Gallo
authors.forename: Francesco
authors.initials: F
authors.lastname: Lapi
authors.forename: Niccolò
authors.initials: N
authors.lastname: Marchionni
authors.forename: Luca
authors.initials: L
authors.lastname: Pani
authors.forename: Sergio
authors.initials: S
authors.lastname: Pecorelli
authors.forename: Daniele
authors.initials: D
authors.lastname: Sancarlo
authors.forename: Angelo
authors.initials: A
authors.lastname: Scuteri
authors.forename: Gianluca
authors.initials: G
authors.lastname: Trifirò
authors.forename: Cristiana
authors.initials: C
authors.lastname: Vitale
authors.forename: Stefano Maria
authors.initials: SM
authors.lastname: Zuccaro
authors.forename: Roberto
authors.initials: R
authors.lastname: Bernabei
authors.forename: Massimo
authors.initials: M
authors.lastname: Fini
mesh_terms: D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D019984:Quality Indicators, Health Care; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors
keywords: OsMed.; Prescribing; Quality indicators