title: Assessing potentially inappropriate prescribing (PIP) and predicting patient outcomes in Ontario's older population: a population-based cohort study applying subsets of the STOPP/START and Beers' criteria in large health administrative databases.
abstract: BACKGROUND
  Adverse drug events (ADEs) are common in older people and contribute significantly to emergency department (ED) visits, unplanned hospitalisations, healthcare costs, morbidity and mortality. Many ADEs are avoidable if attention is directed towards identifying and preventing inappropriate drug use and undesirable drug combinations. Tools exist to identify potentially inappropriate prescribing (PIP) in clinical settings, but they are underused. Applying PIP assessment tools to population-wide health administrative data could provide an opportunity to assess the impact of PIP on individual patients as well as on the healthcare system. This would open new possibilities for interventions to monitor and optimise medication management on a broader, population-level scale.
  
  
  METHODS
  The aim of this study is to describe the occurrence of PIP in Ontario's older population (aged 65 years and older), and to assess the health outcomes and health system costs associated with PIP-more specifically, the association between PIP and the occurrence of ED visits, hospitalisations and death, and their related costs. This will be done within the framework of a population-based retrospective cohort study using Ontario's large health administrative and population databases. Eligible patients aged 66 years and older who were issued at least 1 prescription between 1 April 2003 and 31 March 2014 (approximately 2 million patients) will be included.
  
  
  BACKGROUND
  Ethical approval was obtained from the Ottawa Health Services Network Ethical Review Board and from the Bruyère Research Institute Ethics Review Board. Dissemination will occur via publication, presentation at national and international conferences, and ongoing exchanges with regional, provincial and national stakeholders, including the Ontario Drug Policy Research Network and the Ontario Ministry of Health and Long-Term Care.
  
  
  BACKGROUND
  Registered with clinicaltrials.gov (registration number: NCT02555891).
authors.affiliation: Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada Bruyère Research Institute, Ottawa, Ontario, Canada ICES@ uOttawa, Ottawa, Ontario, Canada School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Lise M
authors.initials: LM
authors.lastname: Bjerre
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Timothy
authors.initials: T
authors.lastname: Ramsay
authors.affiliation: Economic and Social Research Institute, Trinity College Dublin, Dublin, Ireland.
authors.forename: Catriona
authors.initials: C
authors.lastname: Cahir
authors.affiliation: School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Cristín
authors.initials: C
authors.lastname: Ryan
authors.affiliation: Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Roland
authors.initials: R
authors.lastname: Halil
authors.affiliation: Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada Bruyère Research Institute, Ottawa, Ontario, Canada School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Barbara
authors.initials: B
authors.lastname: Farrell
authors.affiliation: ICES@ uOttawa, Ottawa, Ontario, Canada School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Kednapa
authors.initials: K
authors.lastname: Thavorn
authors.affiliation: ICES@ uOttawa, Ottawa, Ontario, Canada.
authors.forename: Christina
authors.initials: C
authors.lastname: Catley
authors.affiliation: ICES@ uOttawa, Ottawa, Ontario, Canada School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Steven
authors.initials: S
authors.lastname: Hawken
authors.affiliation: School of Pharmacy, University of Uppsala, Uppsala, Sweden.
authors.forename: Ulrika
authors.initials: U
authors.lastname: Gillespie
authors.affiliation: Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada Bruyère Research Institute, Ottawa, Ontario, Canada ICES@ uOttawa, Ottawa, Ontario, Canada School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Manuel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D011307:Drug Prescriptions / Q000592:standards*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D016015:Logistic Models; D008134:Long-Term Care / Q000592:standards*; D008297:Male; D015999:Multivariate Analysis; D009864:Ontario; D000067561:Potentially Inappropriate Medication List; D011379:Prognosis; D012107:Research Design; D012189:Retrospective Studies
keywords: EPIDEMIOLOGY; GERIATRIC MEDICINE