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Fialová D, Topinková E, Gambassi G, et al. Potentially Inappropriate Medication Use Among Elderly Home Care Patients in Europe. JAMA. 2005;293(11):1348–1358. doi:10.1001/jama.293.11.1348
Author Affiliations: Department of Geriatrics
and Gerontology, 1st Medical Faculty, Charles University, Prague, Czech Republic
(Drs Fialová and Topinková); Department of Social and Clinical
Pharmacy, Faculty of Pharmacy, Hradec Králové, Czech Republic
(Dr Fialová); Centro Medicina Invecchiamento, Università Cattolica
del Sacro Cuore, Rome, Italy (Drs Gambassi, Onder, and Bernabei); STAKES/CHESS
(National Research and Development Center for Social Welfare and Health),
Helsinki, Finland (Dr Finne-Soveri); Department of Geriatrics, Landspitali
University Hospital, University of Iceland, Reykjavik, Iceland (Dr Jónsson);
Centre for Health Service Studies, The University of Kent & East Kent
Hospitals NHS Trust, Canterbury, England (Dr Carpenter); Bispebjerg Hospital,
Copenhagen, Denmark (Dr Schroll); The Decon College, Oslo, Norway (Ms Sørbye);
NIVEL (Netherland Institute for Health Services Research), Utrecht, the Netherlands
(Dr Wagner); and EuroMISE Centre, Institute of Computer Science AS CR, Prague,
Czech Republic (Dr Reissigová).
Context Criteria for potentially inappropriate medication use among elderly
patients have been used in the past decade in large US epidemiological surveys
to identify populations at risk and specifically target risk-management strategies.
In contrast, in Europe little information is available about potentially inappropriate
medication use and is based on small studies with uncertain generalizability.
Objective To estimate the prevalence and associated factors of potentially inappropriate
medication use among elderly home care patients in European countries.
Design, Setting, and Participants Retrospective cross-sectional study of 2707 elderly patients receiving
home care (mean [SD] age, 82.2 [ 7.2] years) representatively enrolled
in metropolitan areas of the Czech Republic, Denmark, Finland, Iceland, Italy,
the Netherlands, Norway, and the United Kingdom. Patients were prospectively
assessed between September 2001 and January 2002 using the Minimum Data Set
in Home Care instrument.
Main Outcome Measures Prevalence of potentially inappropriate medication use was documented
using all expert panels criteria for community-living elderly persons (Beers
and McLeod). Patient-related characteristics independently associated with
inappropriate medication use were identified with a multiple logistic regression
Results Combining all 3 sets of criteria, we found that 19.8% of patients in
the total sample used at least 1 inappropriate medication; using older 1997
criteria it was 9.8% to 10.9%. Substantial differences were documented between
Eastern Europe (41.1% in the Czech Republic) and Western Europe (mean 15.8%,
ranging from 5.8% in Denmark to 26.5% in Italy). Potentially inappropriate
medication use was associated with patient’s poor economic situation
(adjusted relative risk [RR], 1.96; 95% confidence interval [CI], 1.58-2.36),
polypharmacy (RR, 1.91; 95% CI, 1.62- 2.22), anxiolytic drug use (RR, 1.82;
95% CI, 1.51-2.15), and depression (RR, 1.29; 95% CI, 1.06-1.55). Negatively
associated factors were age 85 years and older (RR, 0.78; 95% CI, 0.65-0.92)
and living alone (RR, 0.76; 95% CI, 0.64-0.89). The odds of potentially inappropriate
medication use significantly increased with the number of associated factors
Conclusions Substantial differences in potentially inappropriate medication use
exist between European countries and might be a consequence of different regulatory
measures, clinical practices, or inequalities in socioeconomic background.
Since financial resources and selected patient-related characteristics are
associated with such prescribing, specific educational strategies and regulations
should reflect these factors to improve prescribing quality in elderly individuals
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