Dr. Rothberg is a recipient of a Doris Duke Clinical Scientist Development Award.
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Original Research
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Potentially inappropriate medication use in hospitalized elders
Article first published online: 25 APR 2008
DOI: 10.1002/jhm.290
Copyright © 2008 Society of Hospital Medicine
Additional Information
How to Cite
Rothberg, M. B., Pekow, P. S., Liu, F., Korc-Grodzicki, B., Brennan, M. J., Bellantonio, S., Heelon, M. and Lindenauer, P. K. (2008), Potentially inappropriate medication use in hospitalized elders. Journal of Hospital Medicine, 3: 91–102. doi: 10.1002/jhm.290
Publication History
- Issue published online: 25 APR 2008
- Article first published online: 25 APR 2008
- Manuscript Accepted: 4 SEP 2007
- Manuscript Revised: 3 SEP 2007
- Manuscript Received: 24 APR 2007
Funded by
- Baystate Medical Education
- Research Foundation Incubator Funds
- Abstract
- Article
- References
- Cited By
Keywords:
- drug safety;
- geriatric patient;
- pharmaceuticals;
- quality improvement
Abstract
BACKGROUND:
Prescribing of potentially harmful medications has not been well documented in hospitals.
OBJECTIVE:
The objective of the study was to determine the rate of and factors associated with potentially inappropriate medication (PIM) prescribing in a large inpatient sample.
DESIGN:
The study was a retrospective cohort of the period between September 1, 2002, and June 30, 2005. We used multivariable logistic regression to identify patient, physician, and hospital characteristics associated with PIM prescribing.
SETTING:
The study collected data from 384 US hospitals.
PATIENTS:
The sample was composed of patients aged ≥65 years admitted with 1 or more of 7 common medical diagnoses.
MEASUREMENTS:
The percentage of patients prescribed PIMs as defined using a modified Beers list was measured. Multivariable-adjusted odds ratios for PIM use were computed.
RESULTS:
Of the 493,971 patients, 49% received at least 1 PIM, and 6% received 3 or more, most commonly promethazine, diphenhydramine, and propoxyphene. Patient, physician, and hospital characteristics were all associated with PIM use. Patients with myocardial infarction or heart failure were most likely (61% and 52% vs. 46% for pneumonia), men (47% vs. 49% for women) and those in managed care plans (44% vs. 49% for other plans) were less likely, and patients ≥85 years were least likely (42% vs. 53% for patients aged 65–74 years) to receive PIMs (P < .0001 for all comparisons). For high-severity PIMs, internists and hospitalists had similar prescribing rates (33%), cardiologists had a higher rate (48%), and geriatricians had the lowest rate (24%). The proportion of elders receiving PIMs ranged from 34% in the Northeast to 55% in the South, and variation at the individual hospital level was extreme. At 7 hospitals, PIMs were never prescribed.
CONCLUSIONS:
Wide variation in the use of PIMs is associated with hospital and physician characteristics. Care may be improved by minimizing this non-patient-centered variation. Journal of Hospital Medicine 2008;3:91–102. © 2008 Society of Hospital Medicine.