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Inappropriate Prescribing
Inappropriate prescribing can be defined as prescribing of medications that have more potential risk than potential benefit or prescribing that does not agree with accepted medical standards.
Epidemiology
The prescribing of inappropriate drugs can be measured by the application of explicit criteria (e.g., “Do not use” lists [commonly referred to as “Beers criteria” in the United States], drug utilization review) or of structured implicit criteria that incorporate clinical review of medical records (e.g., Medication Appropriateness Index). Inappropriate prescribing may include problems with suboptimal choice, dosing, duration, duplication, drug–drug interactions, and drug–disease interactions. Depending on which measurement approach is used, the prevalence of inappropriate prescribing in older adults has been reported to range from 14% to 92%. The risk factors for inappropriate prescribing are not well defined but likely involve a combination of patient, provider, and system factors. Complications of inappropriate prescribing may include functional status decline, worsening of self-rated health, increased hospitalization, and mortality.
Interventions to Improve Inappropriate Prescribing
A number of different approaches to improve prescribing have been examined, including the innovation of “academic detailing” (where a health educator instructs a physician in his or her office), computer order entry and feedback, drug utilization review, formulary and other restrictions, community education, opinion leader and physician education, clinical pharmacist activities, and multidisciplinary specialized geriatric team care approaches. Evidence from randomized controlled health services intervention trials suggests that clinical pharmacy and multidisciplinary team interventions can consistently improve inappropriate prescribing for the elderly. Few trials are of sufficient size to document improvement in patient outcomes (e.g., death, disease, dollars, disability, discomfort, dissatisfaction).
Recommendations
One approach to improve inappropriate prescribing is to require geriatric pharmacotherapy training for medical, nursing, and pharmacy school students, residents, and fellows. Implementing electronic prescribing with helpful medication decision support tools and regular (at least annual) drug regimen reviews is also likely to reduce inappropriate prescribing. Future research is necessary to develop new and better measures of inappropriate prescribing that have established predictive validity. Moreover, further large-scale multicenter intervention studies are needed to determine their impact not only on process measures but also on distal health outcomes (e.g., adverse drug reactions, functional status and health services use, associated costs).
- inappropriate prescribing
Further Readings and References
- Aging and the Brain
- Alzheimer's Disease
- Apolipoprotein E
- Consortium to Establish a Registry for Alzheimer's Disease
- Creutzfeldt–Jakob Disease
- Delirium and Confusional States
- Imaging of the Brain
- Lewy Body Dementia
- Mental Status Assessment
- Mild Cognitive Impairment
- Neurobiology of Aging
- Neurological Disorders
- Pick's Disease
- Stroke
- Syncope
- Vascular Dementia
- Vascular Depression
- Diseases and Medical Conditions
- Accelerated Aging Syndromes
- Anemia
- Aneurysms
- Arrhythmias
- Arthritis and Other Rheumatic Diseases
- Calcium Disorders of Aging
- Cancer
- Cancer Prevention and Screening
- Cancer, Common Types of
- Cataracts
- Cellulitis
- Congestive Heart Failure
- Diabetes
- Ear Diseases
- Eye Diseases
- Foot Problems
- Fractures in Older Adults
- Gastrointestinal Aging
- HIV and AIDS
- Hypertension
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- Immune Function
- Incontinence
- Infections, Bladder and Kidney
- Infectious Diseases
- Kidney Aging and Diseases
- Men's Health
- Menopause and Hormone Therapy
- Metabolic Syndrome
- Musculoskeletal Aging: Inflammation
- Musculoskeletal Aging: Osteoarthritis
- Oral Health
- Osteoporosis
- Pneumonia and Tuberculosis
- Pressure Ulcers
- Sarcopenia
- Shingles
- Skin Neoplasms, Benign and Malignant
- Spinal Stenosis
- Systemic Infections
- Temperature Regulation
- Thyroid Disease
- Valvular Heart Disease
- Venous Stasis Ulcers
- Wound Healing
- Drug-Related Issues
- Function and Syndromes
- Mental Health and Psychology
- Agitation
- Alcohol Use and Abuse
- Anxiety Disorders
- Behavioral Disorders in Dementia
- Bereavement and Grief
- Control
- Delirium and Confusional States
- Depression and Other Mood Disorders
- Emotions and Emotional Stability
- Expectations Regarding Aging
- Life Course Perspective on Adult Development
- Loneliness
- Memory
- Mental Status Assessment
- Mild Cognitive Impairment
- Motivation
- Personality Disorders
- Positive Attitudes and Health
- Posttraumatic Stress Disorder
- Pseudodementia
- Psychiatric Rating Scales
- Psychosocial Theories
- Schizophrenia, Paranoia, and Delusional Disorders
- Selective Optimization With Compensation
- Self-Care
- Self-Efficacy
- Self-Rated Health
- Stress
- Subjective Well-Being
- Successful Aging
- Suicide and the Elderly
- Vascular Depression
- Nutritional Issues
- Physical Status
- Allostatic Load and Homeostasis
- Biological Theories of Aging
- Biomarkers of Aging
- Body Composition
- Body Mass Index
- Cardiovascular System
- Compression of Morbidity
- Fluid and Electrolytes
- Hearing
- Men's Health
- Multiple Morbidity and Comorbidity
- Normal Physical Aging
- Perioperative Issues
- Pulmonary Aging
- Skin Changes
- Skin Neoplasms, Benign and Malignant
- Sleep
- Surgery
- Temperature Regulation
- Therapeutic Failure
- Vision and Low Vision
- Women's Health
- Prevention
- Sociodemographic and Cultural Factors
- Active Life Expectancy
- Africa
- African Americans
- Age–Period–Cohort Distinctions
- Asia
- Asian and Pacific Islander Americans
- Australia and New Zealand
- Canada
- Caregiving
- Centenarians
- Compression of Morbidity
- Critical Perspectives in Gerontology
- Demography of Aging
- Disasters and Terrorism
- Disclosure
- Early Adversity and Late-Life Health
- Economics of Aging
- Education and Health
- Elder Abuse and Neglect
- Environmental Health
- Epidemiology of Aging
- Ethical Issues and Aging
- Ethnicity and Race
- Europe
- Expectations Regarding Aging
- Global Aging
- Health Communication
- Hispanics
- Homelessness and Health in the United States
- Latin America and the Caribbean
- Life Course Perspective on Adult Development
- Living Arrangements
- Loneliness
- Longevity
- Marital Status
- Mexico
- Midlife
- Migration
- Multiple Morbidity and Comorbidity
- Native Americans and Alaska Natives
- Negative Interaction and Health
- Oldest Old
- Quality of Life
- Rural Health and Aging Versus Urban Health and Aging
- Social Networks and Social Support
- Socioeconomic Status
- Stress
- Successful Aging
- Work, Health, and Retirement
- Studies of Aging
- Aging in Manitoba Longitudinal Study
- Cardiovascular Health Study
- Clinical Trials
- Critical Perspectives in Gerontology
- Duke Longitudinal Studies
- Epidemiology of Aging
- Established Populations for Epidemiologic Studies of the Elderly
- Government Health Surveys
- Health and Retirement Study
- Hispanic Established Population for Epidemiologic Studies of the Elderly
- Honolulu–Asia Aging Study, Honolulu Heart Program
- Longitudinal Research
- Longitudinal Study of Aging
- MacArthur Study of Successful Aging
- National Health Interview Survey
- National Long Term Care Survey
- Normative Aging Study
- Qualitative Research on Aging
- Twin Studies
- Systems of Care
- Advance Directives
- Advocacy Organizations
- Aging Network
- Assisted Living
- Caregiving
- Complementary and Alternative Medicine
- Continuum of Care
- Death, Dying, and Hospice Care
- Elder Abuse and Neglect
- Ethical Issues and Aging
- Geriatric Profession
- Geriatric Team Care
- Gerontological Nursing
- Health and Public Policy
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- Home Care
- Institutional Care
- Legal Issues
- Long-Term Care
- Long-Term Care Insurance
- Managed Care
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- Minimum Data Set
- National Institute on Aging
- Nursing Roles in Health Care and Long-Term Care
- Outcome and Assessment Information Set (OASIS)
- Palliative Care and the End of Life
- Patient Safety
- Pets in Health Care Settings
- Rehabilitation Therapies
- Self-Care
- Social Work Roles in Health and Long-Term Care
- Telemedicine
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