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Posted on 08.12.04
CERTs Study Finds Inappropriate Drug Prescribing Among Elderly
By Martha C. Rundles
According to a new study released by the University of Arizona Health Sciences Center for Education and Research on Therapeutics (CERTs), 21 percent of elderly patients recently filled a prescription for more than one drug considered potentially inappropriate for use in persons over the age of 65. The article, published in the August 9 issue of Archives of Internal Medicine, confirmed that potentially inappropriate medications continue to be prescribed to the elderly, despite revised lists of drugs of concern specific to the senior population.
“Frankly, we were surprised to see that these medications continue to be so commonly prescribed in the elderly,” said Dr. Lesley Curtis, one of the CERTs investigators at Duke University Medical Center and the lead author of the article.
Senior citizens comprise less than 15 percent of the United States population, but they account for nearly one third of the prescription drugs consumed annually. To determine the extent of suboptimal prescribing, CERTs researchers analyzed the outpatient claims of a large national pharmaceutical benefit company, which included nearly 800,000 persons over the age of 65 who had filled one or more prescription drug claim in 1999.
Inappropriate medications, or drugs of concern, were identified according to criteria set by an expert panel of physicians and pharmacologists, as defined by the Beers list of drugs. All the drugs on the list should generally be avoided by the elderly.
Investigators found that 162,370 patients, or 21 percent, filled a prescription for one or more drugs of concern in 1999. Further, 15 percent of patients filled prescriptions for 2 drugs of concern, and 4 percent with more than 3 drugs of concern. Fifty-one percent of the subjects of all the claims of Beers listed drugs were for drugs with potentially severe adverse effects.
Psychotropic drugs (often prescribed for mental health reasons) and neuromuscular agents (prescribed to act on skeletal muscle) were the majority of the drugs prescribed. Amitriptyline and doxepin, 2 commonly prescribed drugs for depression, made up 19.5 percent of all claims for Beers listed drugs. Antidepressants accounted for 23 percent of the total claims for prescriptions on the Beers list.
The study concluded that the common use of potentially inappropriate drugs should serve as a reminder for physicians and pharmacists alike to monitor their use carefully. Pharmaceutical claims databases can be important tools for this, but clinical and laboratory data are needed to improve sensitivity and specificity of patient-specific alerts.
Joining Dr. Curtis were Truls Ostbye, MD, PhD, of Duke University Medical Center, Department of Community and Family; Veronica Sendersky, PharmD, of Duke Clinical Research Institute, Center for Clinical and Genetic Economics; Steve Hutchison, PhD, of Advance PCS; Peter E. Dans, MD, and Alan Wright, MD, MPH, both of AdvancePCS Clinical Services; Raymond L. Woosley, MD, PhD, principle investigator at the University of Arizona Health Sciences CERTs Center; and Kevin A. Schulman, MD, of Duke Clinical Research Institute, Center for Clinical and Genetic Economics.
Funding for the study was provided through a research grant from the Agency for Healthcare Research and Quality.