Impact of potentially inappropriate prescribing on adverse drug events, health related quality of life and emergency hospital attendance in older people attending general practice: A prospective cohort study

Emma Wallace; Ronald McDowell; Kathleen Bennett; Tom Fahey; Susan M. Smith

doi:10.1093/gerona/glw140

Impact of potentially inappropriate prescribing on adverse drug events, health related quality of life and emergency hospital attendance in older people attending general practice: A prospective cohort study

Emma Wallace, Ronald McDowell, Kathleen Bennett, Tom Fahey, Susan M. Smith

Research output: Contribution to journal › Article › peer-review

123 Citations (Scopus)

Abstract

Background: Potentially inappropriate prescribing (PIP) describes medications where risk generally outweighs benefit for older people. Cross-sectional studies suggest an association between PIP and poorer health outcomes but there is a paucity of prospective cohort studies. This study investigates the longitudinal association of PIP with adverse drug events (ADEs), health related quality of life, and accident & emergency visits. Methods: Study design: Two-year (2010-2012) prospective cohort study (n = 904, ≥70 years, community-dwelling) with linked pharmacy dispensing data. Exposure: Baseline PIP: Screening Tool for Older Persons potentially Inappropriate Prescriptions (STOPP) and Beers 2012 applied 12 months prior. Study outcomes: ADEs (patient interview), health related quality of life (EQ-5D-3L: patient questionnaire), and accident & emergency visits (general practice medical record review). Statistical analysis: Descriptive statistics: Poisson (incidence rate ratio [95% confidence interval [CI]], linear regression models [regression coefficient [95% CI]], and logistic [odds ratio [OR] [95% CI]). Results: Of 791 participants eligible for follow-up, 673 (85%) returned a questionnaire and 605 (77%) also completed an ADE interview. Baseline STOPP PIP prevalence was 40% and 445 (74%) patients reported ≥1 ADE at follow-up. In multivariable analysis, ≥2 STOPP PIP was associated with ADEs (adjusted incidence rate ratio: 1.29 [95% CI 1.03, 1.85; p =. 03]; poorer health related quality of life [adjusted regression coefficient:-0.11 [95% CI-0.16,-0.06; p <. 001]]; and, ≥1 accident & emergency visit [adjusted OR: 1.85 [95% CI 1.06, 3.24; p =. 03]]). Baseline Beers 2012 prevalence was 26% and there was no association with adverse health outcomes in multivariable analysis. Conclusions: Older community-dwelling people, prescribed ≥2 STOPP PIP are more likely to report ADEs, poorer health related quality of life and attend the accident & emergency department over 2-year follow-up.

Original language	English
Pages (from-to)	271-277
Number of pages	7
Journal	Journals of Gerontology - Series A Biological Sciences and Medical Sciences
Volume	72
Issue number	2
DOIs	https://doi.org/10.1093/gerona/glw140
Publication status	Published (in print/issue) - 1 Feb 2017

Bibliographical note

Publisher Copyright:
© 2016 The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America.

Keywords

Adverse drug events
Community-dwelling
Potentially inappropriate prescribing

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Wallace, E., McDowell, R., Bennett, K., Fahey, T., & Smith, S. M. (2017). Impact of potentially inappropriate prescribing on adverse drug events, health related quality of life and emergency hospital attendance in older people attending general practice: A prospective cohort study. Journals of Gerontology - Series A Biological Sciences and Medical Sciences, 72(2), 271-277. https://doi.org/10.1093/gerona/glw140

Wallace, Emma ; McDowell, Ronald ; Bennett, Kathleen et al. / Impact of potentially inappropriate prescribing on adverse drug events, health related quality of life and emergency hospital attendance in older people attending general practice : A prospective cohort study. In: Journals of Gerontology - Series A Biological Sciences and Medical Sciences. 2017 ; Vol. 72, No. 2. pp. 271-277.

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title = "Impact of potentially inappropriate prescribing on adverse drug events, health related quality of life and emergency hospital attendance in older people attending general practice: A prospective cohort study",

abstract = "Background: Potentially inappropriate prescribing (PIP) describes medications where risk generally outweighs benefit for older people. Cross-sectional studies suggest an association between PIP and poorer health outcomes but there is a paucity of prospective cohort studies. This study investigates the longitudinal association of PIP with adverse drug events (ADEs), health related quality of life, and accident & emergency visits. Methods: Study design: Two-year (2010-2012) prospective cohort study (n = 904, ≥70 years, community-dwelling) with linked pharmacy dispensing data. Exposure: Baseline PIP: Screening Tool for Older Persons potentially Inappropriate Prescriptions (STOPP) and Beers 2012 applied 12 months prior. Study outcomes: ADEs (patient interview), health related quality of life (EQ-5D-3L: patient questionnaire), and accident & emergency visits (general practice medical record review). Statistical analysis: Descriptive statistics: Poisson (incidence rate ratio [95% confidence interval [CI]], linear regression models [regression coefficient [95% CI]], and logistic [odds ratio [OR] [95% CI]). Results: Of 791 participants eligible for follow-up, 673 (85%) returned a questionnaire and 605 (77%) also completed an ADE interview. Baseline STOPP PIP prevalence was 40% and 445 (74%) patients reported ≥1 ADE at follow-up. In multivariable analysis, ≥2 STOPP PIP was associated with ADEs (adjusted incidence rate ratio: 1.29 [95% CI 1.03, 1.85; p =. 03]; poorer health related quality of life [adjusted regression coefficient:-0.11 [95% CI-0.16,-0.06; p <. 001]]; and, ≥1 accident & emergency visit [adjusted OR: 1.85 [95% CI 1.06, 3.24; p =. 03]]). Baseline Beers 2012 prevalence was 26% and there was no association with adverse health outcomes in multivariable analysis. Conclusions: Older community-dwelling people, prescribed ≥2 STOPP PIP are more likely to report ADEs, poorer health related quality of life and attend the accident & emergency department over 2-year follow-up.",

keywords = "Adverse drug events, Community-dwelling, Potentially inappropriate prescribing",

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Wallace, E, McDowell, R, Bennett, K, Fahey, T & Smith, SM 2017, 'Impact of potentially inappropriate prescribing on adverse drug events, health related quality of life and emergency hospital attendance in older people attending general practice: A prospective cohort study', Journals of Gerontology - Series A Biological Sciences and Medical Sciences, vol. 72, no. 2, pp. 271-277. https://doi.org/10.1093/gerona/glw140

Impact of potentially inappropriate prescribing on adverse drug events, health related quality of life and emergency hospital attendance in older people attending general practice: A prospective cohort study. / Wallace, Emma; McDowell, Ronald; Bennett, Kathleen et al.
In: Journals of Gerontology - Series A Biological Sciences and Medical Sciences, Vol. 72, No. 2, 01.02.2017, p. 271-277.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Impact of potentially inappropriate prescribing on adverse drug events, health related quality of life and emergency hospital attendance in older people attending general practice

T2 - A prospective cohort study

AU - Wallace, Emma

AU - McDowell, Ronald

AU - Bennett, Kathleen

AU - Fahey, Tom

AU - Smith, Susan M.

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Background: Potentially inappropriate prescribing (PIP) describes medications where risk generally outweighs benefit for older people. Cross-sectional studies suggest an association between PIP and poorer health outcomes but there is a paucity of prospective cohort studies. This study investigates the longitudinal association of PIP with adverse drug events (ADEs), health related quality of life, and accident & emergency visits. Methods: Study design: Two-year (2010-2012) prospective cohort study (n = 904, ≥70 years, community-dwelling) with linked pharmacy dispensing data. Exposure: Baseline PIP: Screening Tool for Older Persons potentially Inappropriate Prescriptions (STOPP) and Beers 2012 applied 12 months prior. Study outcomes: ADEs (patient interview), health related quality of life (EQ-5D-3L: patient questionnaire), and accident & emergency visits (general practice medical record review). Statistical analysis: Descriptive statistics: Poisson (incidence rate ratio [95% confidence interval [CI]], linear regression models [regression coefficient [95% CI]], and logistic [odds ratio [OR] [95% CI]). Results: Of 791 participants eligible for follow-up, 673 (85%) returned a questionnaire and 605 (77%) also completed an ADE interview. Baseline STOPP PIP prevalence was 40% and 445 (74%) patients reported ≥1 ADE at follow-up. In multivariable analysis, ≥2 STOPP PIP was associated with ADEs (adjusted incidence rate ratio: 1.29 [95% CI 1.03, 1.85; p =. 03]; poorer health related quality of life [adjusted regression coefficient:-0.11 [95% CI-0.16,-0.06; p <. 001]]; and, ≥1 accident & emergency visit [adjusted OR: 1.85 [95% CI 1.06, 3.24; p =. 03]]). Baseline Beers 2012 prevalence was 26% and there was no association with adverse health outcomes in multivariable analysis. Conclusions: Older community-dwelling people, prescribed ≥2 STOPP PIP are more likely to report ADEs, poorer health related quality of life and attend the accident & emergency department over 2-year follow-up.

AB - Background: Potentially inappropriate prescribing (PIP) describes medications where risk generally outweighs benefit for older people. Cross-sectional studies suggest an association between PIP and poorer health outcomes but there is a paucity of prospective cohort studies. This study investigates the longitudinal association of PIP with adverse drug events (ADEs), health related quality of life, and accident & emergency visits. Methods: Study design: Two-year (2010-2012) prospective cohort study (n = 904, ≥70 years, community-dwelling) with linked pharmacy dispensing data. Exposure: Baseline PIP: Screening Tool for Older Persons potentially Inappropriate Prescriptions (STOPP) and Beers 2012 applied 12 months prior. Study outcomes: ADEs (patient interview), health related quality of life (EQ-5D-3L: patient questionnaire), and accident & emergency visits (general practice medical record review). Statistical analysis: Descriptive statistics: Poisson (incidence rate ratio [95% confidence interval [CI]], linear regression models [regression coefficient [95% CI]], and logistic [odds ratio [OR] [95% CI]). Results: Of 791 participants eligible for follow-up, 673 (85%) returned a questionnaire and 605 (77%) also completed an ADE interview. Baseline STOPP PIP prevalence was 40% and 445 (74%) patients reported ≥1 ADE at follow-up. In multivariable analysis, ≥2 STOPP PIP was associated with ADEs (adjusted incidence rate ratio: 1.29 [95% CI 1.03, 1.85; p =. 03]; poorer health related quality of life [adjusted regression coefficient:-0.11 [95% CI-0.16,-0.06; p <. 001]]; and, ≥1 accident & emergency visit [adjusted OR: 1.85 [95% CI 1.06, 3.24; p =. 03]]). Baseline Beers 2012 prevalence was 26% and there was no association with adverse health outcomes in multivariable analysis. Conclusions: Older community-dwelling people, prescribed ≥2 STOPP PIP are more likely to report ADEs, poorer health related quality of life and attend the accident & emergency department over 2-year follow-up.

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KW - Community-dwelling

KW - Potentially inappropriate prescribing

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Wallace E, McDowell R, Bennett K, Fahey T, Smith SM. Impact of potentially inappropriate prescribing on adverse drug events, health related quality of life and emergency hospital attendance in older people attending general practice: A prospective cohort study. Journals of Gerontology - Series A Biological Sciences and Medical Sciences. 2017 Feb 1;72(2):271-277. doi: 10.1093/gerona/glw140

Impact of potentially inappropriate prescribing on adverse drug events, health related quality of life and emergency hospital attendance in older people attending general practice: A prospective cohort study

Abstract

Bibliographical note

Keywords

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