title: Why do family doctors prescribe potentially inappropriate medication to elderly patients?
abstract: Based on changes in pharmacokinetics and -dynamics in elderly patients, there are potentially inappropriate medications (PIM) that should be avoided in patients aged ≥ 65 years. Current studies showed prescription rates of PIM between 22.5 and 28.4 % in the primary care setting. The evidence concerning reasons for PIM prescription by FPs is limited.
  
  
  
  This mixed method study consisted of three research parts: 1) semi-standardized content analysis of patients' records, 2) qualitative interviews with FPs using a) open questions and b) selected patient-specific case vignettes and 3) qualitative interviews with FPs' medical assistants. The integration of qualitative interviews was used to explain the quantitative results (triangulation design). PIM were identified according to the German PRISCUS list. Descriptive and multivariate statistical analysis was done using SPSS 22.0. Qualitative content analysis of interviews was used to classify the content of the interviews for indicating pertinent categories. All data were pseudonymously recorded and analyzed.
  
  
  
  Content analysis of 1846 patients' records and interviews with 7 related FPs were conducted. Elderly patients [n = 1241, mean age: 76, females: 56.6 %] were characterized in average by 8.3 documented chronic diagnosis. 23.9 % of elderly patients received at least one PIM prescription. Sedatives/hypnotics were the most frequent prescribed PIM-drugs (13.7 %). Mental disorders, gender and number of long-term medication were detected as predictors for the probability of a PIM prescription. Common reported reasons for PIM prescription by FPs concerned limited knowledge regarding PIM, limited applicability of PIM lists in daily practice, lack of time, having no alternatives in medication, stronger patient-related factors than age that influence prescription, own bad experiences regarding changes of medication or refusal of following prescriptions of sedative/hypnotics.
  
  
  
  It is essential to see FPs in a complex decision making situation with several influencing factors on their prescribing, including: patient-oriented prioritization, FPs' experiences in daily practice, FPs' knowledge regarding existing recommendations and their trust in it and organizational characteristics of FPs' daily medical practice. These pros and cons of PIM prescription in elderly patients should be considered in FPs' advanced training.
authors.affiliation: Department of General Practice/Medical Clinic III, Medical School, Technische Universität Dresden, Dresden, Germany. Karen.Voigt@uniklinikum-dresden.de.
authors.forename: Karen
authors.initials: K
authors.lastname: Voigt
authors.affiliation: Department of General Practice/Medical Clinic III, Medical School, Technische Universität Dresden, Dresden, Germany.
authors.forename: Mandy
authors.initials: M
authors.lastname: Gottschall
authors.affiliation: Department of Health Care Management and Public Health, Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany.
authors.forename: Juliane
authors.initials: J
authors.lastname: Köberlein-Neu
authors.affiliation: Department of General Practice/Medical Clinic III, Medical School, Technische Universität Dresden, Dresden, Germany.
authors.forename: Jeannine
authors.initials: J
authors.lastname: Schübel
authors.affiliation: Department of General Practice/Medical Clinic III, Medical School, Technische Universität Dresden, Dresden, Germany.
authors.forename: Nadine
authors.initials: N
authors.lastname: Quint
authors.affiliation: Department of General Practice/Medical Clinic III, Medical School, Technische Universität Dresden, Dresden, Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Bergmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D002983:Clinical Competence; D015897:Comorbidity; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy; D008875:Middle Aged; D019338:Polypharmacy; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors
chemical_list: D006993:Hypnotics and Sedatives
keywords: Family doctor; Mixed methods; Polypharmacy; Potentially inappropriate medication