title: Potentially inappropriate prescribing in two populations with differing socio-economic profiles: a cross-sectional database study using the PROMPT criteria.
abstract: OBJECTIVE
  The purpose of this study is to establish the prevalence of potentially inappropriate prescribing (PIP) in middle-aged adults (45-64 years) in two populations with differing socio-economic profiles, and to investigate factors associated with PIP, using the PROMPT (PRescribing Optimally in Middle-aged People's Treatments) criteria.
  
  
  METHODS
  A retrospective cross-sectional study was conducted using 2012 data from the Enhanced Prescribing Database (EPD), covering the full population in Northern Ireland and the Health Services Executive Primary Care Reimbursement Service (HSE-PCRS) database, covering the most socio-economically deprived third of the population in this age group in the Republic of Ireland. The prevalence for each PROMPT criterion and overall prevalence of PIP were calculated. Logistic regression was used to investigate the association between PIP and gender, age group and polypharmacy.
  
  
  RESULTS
  This study included 441,925 patients from the EPD and 309,748 patients from the HSE-PCRS database. Polypharmacy was common in both datasets (46.7 % in the HSE-PCRS and 20.3 % in the EPD). The prevalence of PIP was 42.9 % (95%CI 42.7, 43.1) in the HSE-PCRS and 21.1 % (95%CI 21.0, 21.2) in the EPD. Age group, female gender and polypharmacy were significantly associated with PIP in both populations (p < 0.05) and polypharmacy had the strongest association.
  
  
  CONCLUSIONS
  PIP is common amongst middle-aged people with the risk of PIP increasing with polypharmacy. Differences in the prevalence of polypharmacy and PIP between the two populations may relate to heterogeneity in healthcare services and different socio-economic profiles, with higher rates of multimorbidity and associated polypharmacy in more deprived groups.
authors.affiliation: Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland. j.cooper@qub.ac.uk.|HRB Centre for Primary Care Research, Division of Population Health Science, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland. j.cooper@qub.ac.uk.
authors.forename: Janine A
authors.initials: JA
authors.lastname: Cooper
authors.affiliation: HRB Centre for Primary Care Research, Division of Population Health Science, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
authors.forename: Frank
authors.initials: F
authors.lastname: Moriarty
authors.affiliation: School of Pharmacy, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
authors.forename: Cristín
authors.initials: C
authors.lastname: Ryan
authors.affiliation: HRB Centre for Primary Care Research, Division of Population Health Science, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Smith
authors.affiliation: Department of Pharmacology & Therapeutics, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Bennett
authors.affiliation: HRB Centre for Primary Care Research, Division of Population Health Science, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
authors.forename: Tom
authors.initials: T
authors.lastname: Fahey
authors.affiliation: HRB Centre for Primary Care Research, Division of Population Health Science, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
authors.forename: Emma
authors.initials: E
authors.lastname: Wallace
authors.affiliation: Department of Pharmacology & Therapeutics, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland.|Economic and Social Research Institute, Whitaker Square, Sir John Roberson's Quay, Dublin 2, Ireland.
authors.forename: Caitriona
authors.initials: C
authors.lastname: Cahir
authors.affiliation: Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
authors.forename: David
authors.initials: D
authors.lastname: Williams
authors.affiliation: Department of Pharmacology & Therapeutics, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland.
authors.forename: Mary
authors.initials: M
authors.lastname: Teeling
authors.affiliation: Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland.|HRB Centre for Primary Care Research, Division of Population Health Science, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hughes
mesh_terms: D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D007494:Ireland; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland; D019338:Polypharmacy; D015995:Prevalence; D012189:Retrospective Studies; D012959:Socioeconomic Factors
keywords: Explicit criteria; Middle-age; PROMPT; Polypharmacy; Potentially inappropriate prescribing
references.citation: Patient Educ Couns. 2005 Feb;56(2):139-46
references.pmid: 15653242
references.citation: Int J Clin Pharmacol Ther. 2008 Feb;46(2):72-83
references.pmid: 18218287
references.citation: Soc Sci Med. 2009 Dec;69(12):1805-12
references.pmid: 19846245
references.citation: Soc Sci Med. 2010 Mar;70(6):934-41
references.pmid: 20096496
references.citation: Br J Clin Pharmacol. 2010 May;69(5):543-52
references.pmid: 20573091
references.citation: BMJ. 2011;342:d3514
references.pmid: 21693525
references.citation: Ageing Res Rev. 2011 Sep;10(4):430-9
references.pmid: 21402176
references.citation: Drugs Aging. 2012 Jun 1;29(6):437-52
references.pmid: 22642779
references.citation: Lancet. 2012 Jul 7;380(9836):37-43
references.pmid: 22579043
references.citation: Eur J Clin Pharmacol. 2012 Oct;68(10):1425-33
references.pmid: 22447297
references.citation: BMJ. 2012;345:e6341
references.pmid: 23036829
references.citation: J Health Serv Res Policy. 2013 Oct;18(4):215-23
references.pmid: 23945679
references.citation: Eur J Clin Pharmacol. 2014 May;70(5):575-81
references.pmid: 24487416
references.citation: Br J Clin Pharmacol. 2014 Jun;77(6):915-6
references.pmid: 24853404
references.citation: Br J Gen Pract. 2014 Jul;64(624):e440-7
references.pmid: 24982497
references.citation: BMC Geriatr. 2014;14:72
references.pmid: 24919523
references.citation: Cochrane Database Syst Rev. 2014;(10):CD008165
references.pmid: 25288041
references.citation: BMC Health Serv Res. 2014;14:484
references.pmid: 25410615
references.citation: J Am Geriatr Soc. 2014 Dec;62(12):2261-72
references.pmid: 25516023
references.citation: Age Ageing. 2015 Mar;44(2):213-8
references.pmid: 25324330
references.citation: J Am Geriatr Soc. 2015 Nov;63(11):2227-46
references.pmid: 26446832
references.citation: Ann Fam Med. 2007 Nov-Dec;5(6):503-10
references.pmid: 18025487
references.citation: Eur J Clin Pharmacol. 2007 Aug;63(8):725-31
references.pmid: 17554532
references.citation: Br J Clin Pharmacol. 2004 Jan;57(1):6-14
references.pmid: 14678335
references.citation: J Clin Epidemiol. 1992 Oct;45(10):1045-51
references.pmid: 1474400
references.citation: CMAJ. 1997 Feb 1;156(3):385-91
references.pmid: 9033421
references.citation: Br J Clin Pharmacol. 2004 Nov;58(5):496-502
references.pmid: 15521897