title: Inappropriate prescribing in a large community-dwelling older population: a focus on prevalence and how it relates to patient and physician characteristics.
abstract: OBJECTIVE
  The prescription of potentially inappropriate medications (PIMs) for older adults is a well-known population health concern. Updated country-specific estimates of inappropriate prescribing in older adults using germane explicit criteria are needed to facilitate physician-tailored quality improvement strategies. Therefore, we sought to determine the prevalence of PIMs for older adults in Emilia-Romagna, Italy, using the updated Maio criteria. We also evaluated patient and general practitioner (GP) characteristics related to inappropriate prescribing.
  
  
  METHODS
  Older adults (≥ 65) in 2012 were evaluated in a one-year retrospective study using administrative health care data. The 2011 Maio criteria includes 25 medications reimbursed by the Italian National Formulary, in the following categories in terms of severity: 16 medications that 'should always be avoided,' 3 that are 'rarely appropriate,' and 6 that have 'some indications although they are often misused.' To evaluate the extent of associations between patient and GP related characteristics, we used generalized estimating equations with an exchangeable covariance design to fit robust logistic regression models.
  
  
  CONCLUSIONS
  A total of 865,354 older adults were in the cohort and 28% had at least one PIM. Of the entire cohort, 8%, 10%, and 14% of individuals were prescribed at least one medication that 'should always be avoided,' is 'rarely appropriate,' and has 'some indications but are often misused,' respectively. Older patients (≥ 75) and females were more likely to be exposed to PIMs. 2,923 GPs were identified in the region, each having prescribed at least one PIM, of which older GPs (≥ 56), male GPs, and solo practice GPs were more likely to prescribe PIMs to their older patients.
  
  
  CONCLUSIONS
  The high prevalence of PIM exposure among older adults is a substantial issue in the region. Knowing how patient and GP characteristics relate to PIMs exposure may improve the design and targeting of initiatives for improving prescribing safety in this population.
authors.affiliation: School of Population Health, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: T B
authors.initials: TB
authors.lastname: Amos
authors.forename: S W
authors.initials: SW
authors.lastname: Keith
authors.forename: S
authors.initials: S
authors.lastname: Del Canale
authors.forename: P
authors.initials: P
authors.lastname: Orsi
authors.forename: M
authors.initials: M
authors.lastname: Maggio
authors.forename: S
authors.initials: S
authors.lastname: Baccarini
authors.forename: G
authors.initials: G
authors.lastname: Gonzi
authors.forename: M
authors.initials: M
authors.lastname: Liu
authors.forename: V
authors.initials: V
authors.lastname: Maio
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D007558:Italy; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D012111:Residence Characteristics; D012189:Retrospective Studies; D017678:Sex Distribution
keywords: aging; general practitioner; medication; patient characteristics; practices; prescribing