Display Settings:

Format

Send to:

Choose Destination
See comment in PubMed Commons below
J Hosp Med. 2008 Mar;3(2):91-102. doi: 10.1002/jhm.290.

Potentially inappropriate medication use in hospitalized elders.

Author information

  • 1Division of General Medicine and Geriatrics, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts 01199, USA. Michael.Rothberg@bhs.org

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 >or=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 >or=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.

(c) 2008 Society of Hospital Medicine.

Comment in

PMID:
18438805
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for John Wiley & Sons, Inc.
    Loading ...
    Write to the Help Desk