Potentially Inappropriate Medication Dispensing in Outpatients: Comparison of Different Measurement Approaches

Purpose of the Research: This paper aims at comparing different approaches to measure potentially inappropriate medication (PIM) with routinely collected data on prescriptions, patient age institutionalization status (ie in nursing home or in the community). A secondary objective is to measure the r...

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Bibliographic Details
Published in:Risk management and healthcare policy 2023-11, Vol.16, p.2565-2578
Main Authors: Eggli, Yves, Halfon, Patricia, Zeukeng, Minette-Joëlle, Kherad, Omar, Schaller, Philippe, Raetzo, Marc-André, Klay, Michael Frédéric, Favre, Benoît Marc, Schaller, Dorian, Marti, Joachim
Format: Article
Language:English
Subjects:
Alzheimer's disease
Antianxiety agents
Comparative analysis
Drug therapy
Drugs
Health maintenance organizations
inappropriateness
low-value care
medication
Methods
Nursing homes
outpatients
switzerland
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Summary:Purpose of the Research: This paper aims at comparing different approaches to measure potentially inappropriate medication (PIM) with routinely collected data on prescriptions, patient age institutionalization status (ie in nursing home or in the community). A secondary objective is to measure the rate and prevalence of PIM dispensing and to identify problematic practices in Switzerland. Material and Methods: The studied population includes about 90,000 insured over 17 years old from a Swiss health maintenance organization in 2019 and 2020. We computed and compared the number of PIM per patient for Beers criteria, Priscus list, Laroche, NORGEP and Prescrire approaches. We also created a composite indicator that accounts for the specificities of the Swiss context (adaptation to the Swiss drugs' market, recommendations in force related to sleeping pills, anxiolytics and NSAIDs). We also stratified the analysis per physician, including initiation and cessation of PIM prescription. Results: Our comparison revealed similarities between the approaches, but also that each of them had specific gaps that provides further motivation for the development of a composite approach. PIM rate was particularly high for sleeping pills, anxiolytics, NSAIDs, even when analyses were limited to chronic use. Drugs with anticholinergic effect were also frequently prescribed. Based on our composite indicator, 27% of insured over 64 years old received at least one PIM in 2020, and 8% received more than one. Our analyses also reveal that for sleeping pills and anxiolytics, half of the volume (or prevalence?) occurs in the
ISSN:1179-1594
1179-1594
DOI:10.2147/RMHP.S427516