Inappropriate drug prescribing in elderly people is common
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《英国医生杂志》
Prescribing drugs to elderly patients that are known to be associated with side effects in older people seems relatively common, despite warnings about such drugs.
Researchers, led by Lesley Curtis of Duke University Medical Center in Durham, North Carolina, and colleagues, investigated the extent that potentially inappropriate drugs are prescribed for elderly patients who are not in hospital ( Archives of Internal Medicine 2004;164: 1621-5).
Inappropriate medications were identified according to criteria set by physicians and pharmacologists, as defined by a list known as the Beers revised list of drugs. The Beers list is a standard compilation of drugs generally believed to commonly cause side effects in elderly people and hence to be avoided.
A 77 year old Chicago woman waits for her prescription to be filled
Credit: TIM BOYLE/GETTY IMAGES
The authors conducted a retrospective cohort study using the outpatient prescription claims database of a pharmaceutical benefit manager, who decides which drugs should be covered by their insurance plan. The data included claims information on the prescriptions of 765 423 people aged over 65 years. The people included in the data were taking drugs that were approved by the benefit manager for cover from the insurance scheme and filed claims for at least one or more prescription drugs during 1999.
In a single year, 162 370 people (21%) filled a prescription for one or more drugs on the Beers list. Amitriptyline and doxepin accounted for 23% of all claims for these medicines, and half of the claims were for drugs with the potential for severe adverse effects.
More than 15% of the patients filled prescriptions for two drugs on the list, and 4% filled prescriptions for three or more drugs. The most commonly prescribed classes of problematic drugs were psychotropic drugs and neuro-muscular drugs.
"Suboptimal prescribing has been an important issue in the elderly population for some time," said Dr Curtis in an interview. "Concerns over the cost of potentially inappropriate medications are warranted, but the potential costs of adverse events related to these medications are of even more concern. This is an area that clearly has not been adequately investigated."
In an accompanying editorial (pp 1603-4), Knight Steel of Hackensack University Medical Center, New Jersey, wrote that the study is evidence of "a significant failure in the American health care system."
"Although the drugs included on such a list may vary depending on the views of the members of the panel, if even half that number of elderly subjects is taking potentially inappropriate medications, one in ten of all older persons are receiving a drug that is potentially not appropriate," Dr Steel wrote.(Scott Gottlieb)
Researchers, led by Lesley Curtis of Duke University Medical Center in Durham, North Carolina, and colleagues, investigated the extent that potentially inappropriate drugs are prescribed for elderly patients who are not in hospital ( Archives of Internal Medicine 2004;164: 1621-5).
Inappropriate medications were identified according to criteria set by physicians and pharmacologists, as defined by a list known as the Beers revised list of drugs. The Beers list is a standard compilation of drugs generally believed to commonly cause side effects in elderly people and hence to be avoided.
A 77 year old Chicago woman waits for her prescription to be filled
Credit: TIM BOYLE/GETTY IMAGES
The authors conducted a retrospective cohort study using the outpatient prescription claims database of a pharmaceutical benefit manager, who decides which drugs should be covered by their insurance plan. The data included claims information on the prescriptions of 765 423 people aged over 65 years. The people included in the data were taking drugs that were approved by the benefit manager for cover from the insurance scheme and filed claims for at least one or more prescription drugs during 1999.
In a single year, 162 370 people (21%) filled a prescription for one or more drugs on the Beers list. Amitriptyline and doxepin accounted for 23% of all claims for these medicines, and half of the claims were for drugs with the potential for severe adverse effects.
More than 15% of the patients filled prescriptions for two drugs on the list, and 4% filled prescriptions for three or more drugs. The most commonly prescribed classes of problematic drugs were psychotropic drugs and neuro-muscular drugs.
"Suboptimal prescribing has been an important issue in the elderly population for some time," said Dr Curtis in an interview. "Concerns over the cost of potentially inappropriate medications are warranted, but the potential costs of adverse events related to these medications are of even more concern. This is an area that clearly has not been adequately investigated."
In an accompanying editorial (pp 1603-4), Knight Steel of Hackensack University Medical Center, New Jersey, wrote that the study is evidence of "a significant failure in the American health care system."
"Although the drugs included on such a list may vary depending on the views of the members of the panel, if even half that number of elderly subjects is taking potentially inappropriate medications, one in ten of all older persons are receiving a drug that is potentially not appropriate," Dr Steel wrote.(Scott Gottlieb)