title: Prevalence of suboptimal drug treatment in patients with and without multidose drug dispensing--a cross-sectional study.
abstract: OBJECTIVE
  The aim of this study was to compare the prevalence of suboptimal drug treatment in older patients with and without multidose drug dispensing (MDD).
  
  
  METHODS
  In 200 hip fracture patients (≥65 years of age), originally recruited to a randomized controlled study in Sahlgrenska University Hospital in 2009, quality of drug treatment at study entry was compared between patients with and without MDD. Two specialist physicians independently assessed and then agreed on the quality of the drug treatment of each patient. Suboptimal drug treatment was defined as ≥1 STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) or ≥1 START (Screening Tool to Alert to Right Treatment) outcome assessed as clinically relevant after individual considerations had been made, i.e. over- or undertreatment (≥1 inappropriate and ≥1 missing drug, respectively).
  
  
  RESULTS
  Patients with MDD (n=100) differed from patients without MDD (n=100) in several ways, for example by being older (87.6 vs. 81.5 years) and using more drugs (8.4 vs. 5.9 drugs). The total number (±standard deviation) of inappropriate and/or missing drugs per person was greater in MDD patients compared with patients without MDD (1.92±1.52 vs. 1.06±1.29, P<0.0001); MDD patients had an additional 0.77 inappropriate drugs and an additional 0.09 missing drugs per person. The prevalence of suboptimal drug treatment was greater in patients with MDD than in those without MDD (86 vs. 55%, P<0.0001). Logistic regression revealed that suboptimal drug treatment was 8.0 times as common in MDD patients, after adjustments for age, sex, number of drugs, cognition, and residence (95% confidence interval 2.4; 26.9). Corresponding figures for over- and undertreatment were 2.9 (1.1; 7.4) and 1.8 (0.8; 4.3), respectively.
  
  
  CONCLUSIONS
  Suboptimal drug treatment, including over- and undertreatment, is more common in MDD patients than in patients who receive their drugs via ordinary prescriptions. The findings confirm safety concerns regarding quality of drug treatment in MDD patients.
authors.affiliation: Närhälsan Dals-Ed Health Center, 668 30, Dals-Ed, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Belfrage
authors.forename: Anders
authors.initials: A
authors.lastname: Koldestam
authors.forename: Christina
authors.initials: C
authors.lastname: Sjöberg
authors.forename: Susanna M
authors.initials: SM
authors.lastname: Wallerstedt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions; D005260:Female; D006785:Hospitals, University; D006801:Humans; D057970:Inappropriate Prescribing; D016015:Logistic Models; D008297:Male; D008509:Medication Systems; D019338:Polypharmacy; D016032:Randomized Controlled Trials as Topic; D013548:Sweden; D019564:Unnecessary Procedures