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 |
Externí odkaz: |