Appropriate medication prescribing in elderly patients: how knowledgeable are primary care physicians? A survey study in Parma, Italy
Article first published online: 19 OCT 2010
© 2010 Blackwell Publishing Ltd
Journal of Clinical Pharmacy and Therapeutics
Volume 36, Issue 4, pages 468–480, August 2011
How to Cite
Maio, V., Jutkowitz, E., Herrera, K., Abouzaid, S., Negri, G. and Del Canale, S. (2011), Appropriate medication prescribing in elderly patients: how knowledgeable are primary care physicians? A survey study in Parma, Italy. Journal of Clinical Pharmacy and Therapeutics, 36: 468–480. doi: 10.1111/j.1365-2710.2010.01195.x
- Issue published online: 6 JUL 2011
- Article first published online: 19 OCT 2010
- Received 22 January 2010, Accepted 24 May 2010
- appropriate prescribing;
- Beers criteria;
- clinical vignettes;
- knowledge of medication;
- primary care physicians
What is known and Objective: Increasing attention is being paid to inappropriate medication prescribing for the elderly. A growing body of studies have detected a prevalence of inappropriate prescribing ranging from 12% to 40% worldwide, including Regione Emilia-Romagna, Italy. To improve quality of prescribing, a multi-phase pilot project in the Local Health Unit (LHU) of Parma, Regione Emilia-Romagna, was established. This phase aimed to assess primary care physicians’ knowledge of appropriate prescribing in elderly patients.
Methods: In total, 155 primary care physicians (51% of the total), convened by the LHU of Parma for an educational session, were asked to complete anonymously a 19-item paper survey. Knowledge of inappropriate medication use in the elderly was assessed using seven clinical vignettes based on the 2002 Beers Criteria. Topics tested included hypertension, osteoarthritis, arrhythmias, insomnia and depression. Data regarding physician’s perceived barriers to appropriate prescribing for elderly patients were also collected. To evaluate the relationship between physician knowledge scores and physician characteristics, physicians were classified as having a ‘low score’ (three or below) or a ‘high score’ (six or more) with respect to their knowledge of prescribing for the elderly.
Results and Discussion: All physicians completed the survey. Most physicians (88%) felt confident in their ability to prescribe appropriate medications for the elderly. Thirty-nine physicians (25%) received a ‘high score’ compared to 26 (17%) who received a ‘low score’. ‘Lower score’ respondents had been in practice for a longer time (P < 0·05) than ‘higher score’ respondents. Perceived barriers to appropriate prescribing included potential drug interactions (79% of respondents) and the large number of medications a patient is already taking (75%).
What is new and Conclusion: The study results show an unsatisfactory knowledge of appropriate prescribing among primary care physicians in the LHU of Parma, especially among older physicians. Educational strategies tailored to primary care physicians should be establish to enhance knowledge in this area and improve quality of prescribing.