Objectives To estimate and compare the prevalence and type of potentially inappropriate prescribing (PIP) and potential prescribing omissions (PPOs) among community-dwelling older adults (≥65 years) enrolled to a clinical trial in three European countries.
Design A secondary analysis of the Thyroid Hormone Replacement for Subclinical Hypothyroidism Trial dataset.
Participants A subset of 48/80 PIP and 22/34 PPOs indicators from the Screening Tool of Older Persons Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) V2 criteria were applied to prescribed medication data for 532/737 trial participants in Ireland, Switzerland and the Netherlands.
Results The overall prevalence of PIP was lower in the Irish participants (8.7%) compared with the Swiss (16.7%) and Dutch (12.5%) participants (P=0.15) and was not statistically significant. The overall prevalence of PPOs was approximately one-quarter in the Swiss (25.3%) and Dutch (24%) participants and lower in the Irish (14%) participants (P=0.04) and the difference was statistically significant. The hypnotic Z-drugs were the most frequent PIP in Irish participants, (3.5%, n=4), while it was non-steroidal anti-inflammatory drug and oral anticoagulant combination, sulfonylureas with a long duration of action, and benzodiazepines (all 4.3%, n=7) in Swiss, and benzodiazepines (7.1%, n=18) in Dutch participants. The most frequent PPOs in Irish participants were vitamin D and calcium in osteoporosis (3.5%, n=4). In the Swiss and Dutch participants, they were bone antiresorptive/anabolic therapy in osteoporosis (9.9%, n=16, 8.6%, n=22) respectively. The odds of any PIP after adjusting for age, sex, multimorbidity and polypharmacy were (adjusted OR (aOR)) 3.04 (95% CI 1.33 to 6.95, P<0.01) for Swiss participants and aOR 1.74 (95% CI 0.79 to 3.85, P=0.17) for Dutch participants compared with Irish participants. The odds of any PPOs were aOR 2.48 (95% CI 1.27 to 4.85, P<0.01) for Swiss participants and aOR 2.10 (95% CI 1.11 to 3.96, P=0.02) for Dutch participants compared with Irish participants.
Conclusions This study has estimated and compared the prevalence and type of PIP and PPOs among this cohort of community-dwelling older people. It demonstrated a significant difference in the prevalence of PPOs between the three populations. Further research is urgently needed into the impact of system level factors as this has important implications for patient safety, healthcare provision and economic costs.
- primary care
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Contributors D.O.R., K.A.W., S.B., P.M.K., N.R. and J.G. conceived the study and were involved in designing the study. Data was provided by P.M.K., N.R. and J.G. and D.O.R. carried out the statistical analysis. D.O.R. wrote the first draft of the paper and all authors contributed to subsequent drafts. P.M.K. is the guarantor.
Funding This research was funded by the Health Research BoardSPHeRE/2013/1. The authors acknowledge financial support from this trial also (EU Project grant agreement number 278148). The work in Switzerland was partially supported by a grant from the Swiss National Science Foundation (SNSF 320030-150025 to Nicolas Rodondi) and by the project “OPERAM: OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly” supported by the European Commission (EC) HORIZON 2020, proposal 634238, and by the Swiss State Secretariat for Education, Research and Innovation (SERI) under contract number 15.0137. The opinions expressed and arguments employedherein are those of the authors and do not necessarily reflect the officialviews of the EC and the Swiss government. C.B. was supported by a grant from the Swiss National Science Foundation (SNSF P2BEP3_165409). T.H.C.’s research is supported by a grant from the Swiss National Science Foundation (PZ00P3-167826). M.R.B’.s research is supported by a grant from the Swiss National Science Foundation (SNSF P2BEP3_175289). The Institute for Evidence-Based Medicine in Old Age (IEMO) is funded by the Dutch Ministry of Health and Welfare and supported by ZonMw (project number 62700.3002).
Disclaimer The opinions expressed and arguments employed herein are those of the authors and do not necessarily reflect the official views of the EC and the Swiss government.
Competing interests None declared.
Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.
Ethics approval Ethical approval was received from the relevant ethics committees at each TRUST site.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Consent was not obtained from participants for data sharing but the presented data are anonymised and risk of identification is low.