High‐risk prescribing in an Irish primary care population: trends and variation

Autor: Catherine Byrne, Kathleen Bennett, Caitriona Cahir, Carmel Curran
Rok vydání: 2017
Předmět:
Male
Pediatrics
Time Factors
Databases
Factual
Digoxin
030204 cardiovascular system & hematology
Drug Utilization Review
0302 clinical medicine
Risk Factors
Odds Ratio
Drug Interactions
Pharmacology (medical)
030212 general & internal medicine
Practice Patterns
Physicians'
Aged
80 and over
education.field_of_study
Middle Aged
Female
Patient Safety
medicine.drug
Adult
medicine.medical_specialty
Drug-Related Side Effects and Adverse Reactions
Population
Pharmacy
Community Pharmacy Services
Primary care
Drug Prescriptions
Risk Assessment
Physicians
Primary Care
Older population
03 medical and health sciences
General Practitioners
Internal medicine
medicine
Humans
Medical prescription
education
Aged
Pharmacology
Primary Health Care
business.industry
Pharmacoepidemiology
Warfarin
Confidence interval
Cross-Sectional Studies
Logistic Models
Multivariate Analysis
Polypharmacy
business
Ireland
Zdroj: British Journal of Clinical Pharmacology. 83:2821-2830
ISSN: 1365-2125
0306-5251
Popis: AIMS The aims of the present study were to examine the prevalence of high-risk prescribing (HRP) in community-dwelling adults in Ireland from 2011-2015 using consensus-validated indicators, factors associated with HRP, and the variation in HRP between general practitioners (GPs) and in the dispensing of high-risk prescriptions between pharmacies. METHODS A repeated cross-sectional national pharmacy claims database study was conducted. Prescribing indicators were based on those developed in formal consensus studies and applicable to pharmacy claims data. Multilevel logistic regression was used to examine factors associated with HRP and dispensing. RESULTS There were significant reductions in the rates of most indicators over time (P < 0.001). A total of 66 022 of 300 906 patients at risk in 2011 [21.9%, 95% confidence interval (CI) 21.8, 22.1%], and 42 109 of 278 469 in 2015 (15.1%, 95% CI 15.0, 15.3%), received ≥1 high-risk prescription (P < 0.001). In 2015, indicators with the highest rates of HRP were prescription of a nonsteroidal anti-inflammatory drug (NSAID) without gastroprotection in those ≥75 years (37.2% of those on NSAIDs), coprescription of warfarin and an antiplatelet agent or high-risk antibiotic (19.5% and 16.2% of those on warfarin, respectively) and prescription of digoxin ≥250 μg day-1 in those ≥65 years (14.0% of those on digoxin). Any HRP increased significantly with age and number of chronic medications (P < 0.001). a) After controlling for patient variables, the variation in the rate of HRP between GPs was significant (P < 0.05); and b) after controlling for patient variables and the prescribing GP, the variation in the rate of dispensing of high-risk prescriptions between pharmacies was significant (P < 0.05). CONCLUSIONS HRP in Ireland has declined over time, although some indicators persist. The variation between GPs and pharmacies suggests the potential for improvement in safe medicines use in community care, particularly in vulnerable older populations.
Databáze: OpenAIRE
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