Patient-and Clinic Visit-Related Factors Associated with Potentially Inappropriate Medication Use among Older Home Healthcare Service Recipients

Chang Chirn-Bin ； Lai Hsiu-Yun ； Yang Shu-Yu ； Wu Ru-Shu ； Liu Hsing-Cheng ； Hsiu-Ying Hsu ； Shinn-Jang Hwang ； Chan Ding-Cheng

《台灣老年醫學暨老年學雜誌》 9卷2期 (2014/05) Pp. 33-33

https://doi.org/10.29461/TGG.201405_9(2).0053

並列摘要

Objective: Studies on potentially inappropriate medications (PIMs) for older home healthcare service recipients are rare, and newer criteria of potentially inappropriate medication have not been applied. The aim of this study was to explore the prevalence of potentially inappropriate medications and the correlation of three different PIM instruments published after 2010 among older home healthcare recipients. Materials and methods: We performed cross-sectional analysis of the Taiwanese National Health Insurance Research Database. A total of 25,187 home healthcare recipients aged more than 65 years in 2009 were included. Medication lists independent of chronic conditions from the 2012 Beers criteria, PIM-Taiwan criteria, and the PRISCUS criteria were used. Analysis was performed separately at a patient and clinic-visit level. T-tests, chi-square analysis, and multivariate logistic regressions were used where appropriate. Results: The prevalence of having at least one PIM at a patient and clinic-visit level was highest with the Beers (82.7%, 36.1% respectively), followed by the PRISCUS (68.5%, 25.1%) and PIM-Taiwan (63%, 19.2%) criteria. At a patient level, polypharmacy (odds ratio (OR) 2.5 to 4.9), higher number of clinic (OR 1.2 to 1.4), hospital (OR 1.2 to 1.6), and physician (OR 1.2 to 1.4) visits were associated with PIM use for all 3 sets of criteria. At a clinic-visit level, internist/family physicians (OR 1.3 to 1.7) and neurologists/psychiatrists (OR 1.7 to 5.8) were the most likely to prescribe PIMs. Psychotropic drugs and first generation antihistamines accounted for most of the top ten PIMs. Conclusion: The prevalence of PIMs was high among older Taiwanese HHSRs. Polypharmacy and certain medical specialties were associated with a higher likelihood of PIM prescriptions. Provider education and medication review and reconciliation should be considered.