Incidence of Potentially Inappropriate Prescribing: Longitudinal Investigation of Outpatient EHR Prescriptions

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society Pub Date : 2024-12-31 DOI:10.1111/jgs.19340

Steven M. Albert, Xiaotong Li, Sandra L. Gill-Kane, Jacob Lombardi, Krishi Akenapalli, Richard D. Boyce

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引用次数: 0

Abstract

Importance

The incidence of potentially inappropriate medication (PIM) prescribing among older adults is not as well studied as its prevalence. Estimates of factors associated with PIM incidence, such as patient age, sex, race-ethnicity, medication subsidy support, and comorbidity, are also limited.

Objective

To estimate the incidence of PIM prescribing in older adult outpatients, as well as the incidence and predictors for each PIM class, in a large outpatient electronic health records (EHR) cohort.

Design

Retrospective study of PIM prescribing among outpatients with encounters leading to prescription orders, 2015–2018, excluding prevalent cases.

Setting

Outpatients receiving care from a multi-site health system in western Pennsylvania.

Participants

342,405 patients, contributing 893,754 person-years of follow-up.

Main Outcomes and Measures

The incidence of PIM prescribing based on automated coding of 2019 Beers criteria. A multivariable Poisson regression model was estimated to assess the impact of age, sex, race-ethnicity, comorbidity, and medication subsidy (PACE/PACENET) on PIM risk. For each PIM class, the association between predictors and time to PIM prescribing was evaluated using proportional hazard models.

Results

The incidence rate (IR) for 1 or more PIM was 193.5 per 1000 person-years, led by short- and intermediate-acting benzodiazepines (37.6), first-generation antihistamines (32.8), and skeletal muscle relaxants (22.0). The incidence of PIM prescribing was 15% higher among white patients and 35% lower among males. High comorbidity (Charlson score ≥ 3) was associated with a 59% higher risk. Participation in the PACE/PACENET program, a medication subsidy program, was associated with an 83% increase in incidence. Each additional year of age was associated with a 1.2% reduction in incidence.

Conclusions and Relevance

This study establishes benchmarks for the incidence of PIM prescribing in outpatients and identifies important disparities in PIM risk, which vary by PIM class.

Abstract Image

查看原文本刊更多论文

潜在不当处方的发生率：门诊电子病历处方的纵向调查。

重要性：在老年人中，潜在不适当药物（PIM）处方的发生率并没有像其患病率那样得到很好的研究。与PIM发病率相关的因素，如患者年龄、性别、种族、药物补贴支持和合并症的估计也很有限。目的：在一个大型门诊电子健康记录（EHR）队列中，估计老年门诊患者PIM处方的发生率，以及每个PIM类别的发生率和预测因素。设计：回顾性研究2015-2018年门诊就诊患者的PIM处方情况，不包括流行病例。背景：在宾夕法尼亚州西部接受多站点医疗系统护理的门诊病人。参与者：342,405例患者，随访893,754人年。主要结果和指标：基于2019年Beers标准自动编码的PIM处方发生率。采用多变量泊松回归模型评估年龄、性别、种族、合并症和药物补贴（PACE/PACENET）对PIM风险的影响。对于每个PIM类别，使用比例风险模型评估预测因子与PIM处方时间之间的关系。结果：1例或1例以上PIM的发病率（IR）为每1000人年193.5例，以短效和中效苯二氮卓类药物（37.6例）、第一代抗组胺药（32.8例）和骨骼肌松弛剂（22.0例）居首。PIM处方的发生率在白人患者中高15%，在男性患者中低35%。高合并症（Charlson评分≥3）与风险增加59%相关。参加PACE/PACENET计划（一项药物补贴计划）与发病率增加83%相关。每增加一岁，发病率降低1.2%。结论和相关性：本研究建立了门诊患者PIM处方发生率的基准，并确定了PIM风险的重要差异，这些差异因PIM类别而异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.