Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-28T14:12:48.712Z Has data issue: false hasContentIssue false
  • English
  • Français

Patient Age as a Factor in Drug Prescribing Practices

Published online by Cambridge University Press:  29 November 2010

Joyce Ann Ferguson
Joyce Ann Ferguson
Affiliation:
University of Oxford
Get access Rights & Permissions [Opens in a new window]

Abstract

This study utilized 1985 United States National Ambulatory Medical Care Survey data to explore the relationship between the drug prescribing phenomenon, measured by inappropriate prescribing and by prescription volume, and patient age. Inappropriate prescribing was relabelled potentially undesirable prescribing because limited medico-social patient information restricting circumstantial knowledge could result in an oversimplified and unduly critical judgment of prescribing. Categories of potentially undesirable prescribing were developed: 1) more than one drug in the same class; 2) drug classes not to be combined; 3) drugs serving sub-optimal treatment; and 4) drugs and diagnoses not to be combined. Of 67 different generic drugs representing 13 drug classes studied, 242 products were prescribed to the sample of 33,574 patients age 45+ years. Potentially undesirable prescribing was found to be a common problem regardless of type of medical practice and the sex of the patient: it is related to the age of the patient. The adverse effect of visiting a general practitioner is greater for older patients; and the adverse effect of attending a practice in a non-metropolitan area is larger for the older patients.

Résumé

Cette étude, qui repose sur les données tirées du sondage national effectué aux Etats-Unis en 1985 sur les soins médicaux ambulatoires, examine le rapport entre l'âge du patient et la prescription de médicaments, mesurée selon la nature inappropriée des ordonnances et leur volume. On a substitué l'expression “ordonnance potentiellement indésirable” à l'expression “ordonnance inappropriée” parce que le fait de disposer de renseignements d'ordre médico-social limités sur le patient, et done d'une connaissance insuffisante de ses antécédents risque, au moment de prescrire un médicament, de rendre le jugement indûment simplifié et critique. Les catégories suivantes ont été établies en ce qui concerne la prescription potentiellement indésirable: 1) plus d'un médicament appartenant à la même catégorie, 2) des catégories de médicaments à ne pas combiner, 3) des medicaments n'assurant qu'un traitement suboptimal et 4) des médicaments et des diagnostics incompatibles. Sur 67 médicaments génériques represéntant 13 catégories de médicaments étudiées, 242 produits ont été prescrits à un échantillon de 33 574 patients âgés de 45 ans ou plus. On a constaté que l'ordonnance potentiellement indésirable était un problème courant quelle que soit la discipline médicale et le sexe du patient, mais qu'il existait un rapport avec l'âge du patient. La consultation d'un médicin généraliste a un effet défavorable plus marque chez les patients âgés, et il en est de même pour la consultation d'un medecin dans les régions non métropolitaines pour ce groupe de personnes.

Keywords

Inappropriate PrescribingDrugsPatient AgePrescription Volume
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 9 , Issue 3 , Autumn/automne 1990 , pp. 278 - 295
Copyright
Copyright © Canadian Association on Gerontology 1990

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alexander, N., Goodwin, J.S., Currie, C. (1985) Comparison of Admission and Discharge Medications in Two Geriatric Populations. Journal of the American Geriatrics Society, 33: 12: 827–832.CrossRefGoogle ScholarPubMed
Anderson, W.F. (1966) The Prevention of Illness in the Elderly: the Rutherglen experiment in medicine in old age. Proceedings of a conference held at the Royal College of Physicians. London: Pitman.Google Scholar
Barrett, J.M. (1978) Drug Medication and the Elderly Patient. New Zealand Medical Journal, 85: 360–362.Google Scholar
Boethius, G. (1972) Recording of Drug Prescriptions in the County of Jamtland, Sweden. Acta Medica Scandinavia, 202: 241–251.CrossRefGoogle Scholar
Borda, I., Jick, H., Slone, D., et al. (1967) Studies of Drug Usage in Five Boston Hospitals. Journal of the American Medical Association, 202: 170.Google ScholarPubMed
Brock, A.M. (1984) Cohort Influence on Drug Use and Consumption. Special Care in Dentistry, 4: 4: 160–164.CrossRefGoogle ScholarPubMed
Butler, R.N., Lewis, M.I. (1977) Aging and Mental Health: positive psychosocial approaches. Second Edition. St Louis: CV Mosby.Google Scholar
Campbell, A.J., McCosh, L., Reinkin, J. (1983) Drugs Taken by a Population Based Sample of Subjects 65 Years and Over in New Zealand. New Zealand Medical Journal, 96: 378–380.Google ScholarPubMed
Castleden, CM., George, C.F., Marcer, D., et al. (1977) Increased Sensitivity to Nitrazepam in Old Age. British Medical Journal, 1: 10–12.CrossRefGoogle ScholarPubMed
Chen, L.H., Liu, S, Cook Newell, M.E., et al. (1985) Survey of Drug Use by the Elderly and Possible Impact of Drugs on Nutritional Status. Drug-Nutrient Interactions, 3: 73–86.Google ScholarPubMed
Christopher, L.J., Ballinger, B.R., Shepherd, A.M.M., et al. (1979) A Survey of Hospitall Prescribing for the Elderly in Crooks, J., Stevenson, I.H. (Eds.): Drugs and the Elderly. Baltimore: University Park Press.Google Scholar
Dominion Bureau of Statistics (1968) Population 1921–1966. Revised Annual Estimates of Population by Sex and Age, Canada and the Provinces, Cat. No. 91–511, census division, Ottawa: Dominion Bureau of Statistics p. 32.Google Scholar
Drug Information 84 (1984) Bethesda, Maryland: American Society of Hospital Pharmacists.Google Scholar
Eisdorfer, C., Cohen, D. (1978) The Cognitively Impaired Elderly: differential diagnosis in Storandt, M., Siegler, I.C., Elias, M.F. (Eds.): The Clinical Psychology of Aging. New York: Plenum Press.Google Scholar
Fisher, C. (1980) Differences by Age Groups in Health Care Spending. Health Care Financing Review, 1: 65–90.Google ScholarPubMed
Folsom, J.C., Boies, B., Pommerenck, K. (1978) Life Adjustment Techniques for Use with the Dysfunctional Elderly. Aged Care and Services Review, 1: 1–12.Google ScholarPubMed
Fries, J. (1980) Aging, Natural Death, and the Compression of Morbidity. New England Journal of Medicine, 303: 130–135.CrossRefGoogle ScholarPubMed
Gilchrist, W.J., Lee, Y.C., MacDonald, J.B., et al. (1987) Prospective Study of Drug Reporting by General Practitioners for an Elderly Population Referred to a Geriatric Service. British Medical Journal, 294: 289–290.CrossRefGoogle ScholarPubMed
Goodman, L.S., Gilman, A.G. (1985) Pharmacological Basis of Therapeutics. Seventh Edition. New York: Macmillan.Google Scholar
Guttman, D. (1978) Patterns of Legal Drug Use by Older Americans. Addictive Disorders, 3: 30: 337–356.Google Scholar
Kalant, H., Roschlau, W.H.E., Sellers, E.M. (1985) Principles of Medical Pharmacology. Fourth Edition. Toronto: University of Toronto Press.Google Scholar
Law, R., Chambers, C. (1976) Medicines and Elderly People: a general practice survey. British Medical Journal, 1: 565–568.CrossRefGoogle ScholarPubMed
Linn, B.S., Linn, M.W. (1982) Patient Symptoms and Physicians Prescribing Patterns in the Elderly. Social Science and Medicine, 16: 1531–1538.CrossRefGoogle ScholarPubMed
Lubitz, J., Prihoda, R. (1983) Use of Medicare Services in the Last Years of Life, In Health, United States 1983. DHHS Publication 84–1232. Washington, DC: Government Printing Office.Google Scholar
McLemore, T., DeLozier, J. (1987) 1985 Summary: National Ambulatory Medical Care Survey. NCHS Advance Data 128, Jan. 23.Google Scholar
Melmon, K.L., Morelli, H.F. (1978) Clinical Pharmacology. Second Edition. New York: Macmillan.Google Scholar
Mock, B. (1977) Rehabilitation of the Elderly Cardiac Patient Hampered by Bias. Geriatrics, 32: 22–23.Google ScholarPubMed
Murdoch, J.C. (1980) The Epidemiology of Prescribing in an Urban General Practice. Journal of the Royal College of General Practitioners, 30: 593–602.Google Scholar
Osborn, R.W. (1988) Professor, Department of Preventive Medicine Biostatistics, University of Toronto, personal communication, November 1988.Google Scholar
Pathy, D.M., Henney, C.R., Quirk, J., et al. (1976) Deviation from Prescribed Drug Treatment after Discharge from Hospital. British Medical Journal, 2: 686–688.Google Scholar
Shaw, S., Opit, L. (1976) Need for Supervision in Elderly Receiving Longterm Meds. British Medical Journal, 7: 505–507.CrossRefGoogle Scholar
Skegg, R., Doll, R., Perry, J. (1977) Use of Medicines in General Practice. British Medical Journal, 1: 1561.CrossRefGoogle ScholarPubMed
Skoll, S.L., August, R.J., Johnson, G.E. (1979) Drug Prescribing for the Elderly in Saskatchewan During 1976. Canadian Medical Association Journal, 121: 1074–1081.Google ScholarPubMed
Soldo, B.J., Manton, K.G. (1985) Changes in the Health Status and Service Needs of the Oldest Old: current patterns and future trends. Millbank Memorial Fund Quarterly, 63: 286–323.CrossRefGoogle Scholar
United Nations (1986) The Aging of Populations and its Economic and Social Implications. New York: UN Department of Economic and Social Affairs, United Nations p. 7.Google Scholar
Vestal, R.E. (1978) Drug Use in the Elderly: a review of problems and special considerations. Drugs, 16: 358–362.CrossRefGoogle ScholarPubMed
Waldo, D., Lazenby, H. (1984) Demographic Characteristics and Health Care Use and Expenditures by the Aged in the United States. Health Care Financing Review, 6: 1–49.Google ScholarPubMed
Williamson, J., Chopin, J.M. (1986) Adverse Reactions to Prescribed Drugs in the Elderly: a multicentre investigation. Age and Ageing, 9: 73–80.CrossRefGoogle Scholar
Wilson, C.W.M., Banks, J.A., Mapes, R.E., et al. (1963) Influence of Different Sources of Therapeutic Information on Prescribing by General Practitioners. British Medical Journal, 2: 599.CrossRefGoogle ScholarPubMed
Wilson, L.A., Lawson, I.R., Brass, W. (1962) Multiple Disorders in the Elderly: a clinical and statistical study. Lancet, 2: 841–843.CrossRefGoogle ScholarPubMed
Wolinsky, F.D., Mosely, R.R., Coe, R.M. (1986) A Cohort Analysis of the Use of Health Services by Elderly Americans. Journal of Health and Social Behavior, 27: 209–219.CrossRefGoogle ScholarPubMed