Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-27T14:13:27.239Z Has data issue: false hasContentIssue false

Pharmaceutical Use among Older Adults: Using Administrative Data to Examine Medication-Related Issues

Published online by Cambridge University Press:  31 March 2010

Colleen Metge*
Affiliation:
Department of Community Health Sciences, Faculty of Medicine, University of Manitoba Faculty of Pharmacy, University of Manitoba
Ruby Grymonpre
Affiliation:
Faculty of Pharmacy, University of Manitoba
Matthew Dahl
Affiliation:
Department of Community Health Sciences, Faculty of Medicine, University of Manitoba Faculty of Pharmacy, University of Manitoba
Marina Yogendran
Affiliation:
Department of Community Health Sciences, Faculty of Medicine, University of Manitoba Faculty of Pharmacy, University of Manitoba
*
Requests for offprints should be sent to: / Les demandes de tirés-à-part doivent être addressées à : Colleen Metge, Ph.D., Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, 727 McDermot Avenue, Suite 408, Winnipeg, MB R3C 3P5. ([email protected])

Abstract

Medication use is recognized as the least expensive, most cost-effective health care intervention. In older adults this is especially important, as they are the largest consumer of prescription medications. We describe the use of a linked data set including pharmaceutical, medical, and hospital claims to examine pharmaceutical use in the population of older adults and then give several examples of its application. Indicators to describe the population's overall use of medication and the appropriate use of specific medication have been developed. Indicators of appropriate use are characterized using the dispensation of benzodiazepines to older adults. We have found that a significant proportion of new users of benzodiazepines are still prescribed a long-acting version (over 10%), signifying potential inappropriate use. The data are also able to describe some significant outcomes from the use of pharmaceuticals such as death, fracture, and population-based clinical measures where available.

Résumé

La consommation de médicaments est reconnue comme la prestation de soins la moins chère et la plus rentable. Cela est particulièrement important chez les aînés, puisqu'il s'agit des personnes qui consomment le plus de médicaments sur ordonnance. Nous décrivons un ensemble de données qui sont liées, y compris des données fournies par l'industrie pharmaceutique, les médecins et les hôpitaux, de manière à étudier la consommation de produits pharmaceutiques chez les personnes âgées, puis nous fournissons plusieurs exemples de mise en oeuvre. Des indicateurs permettant de déterminer la consommation de médicaments globale dans la population ainsi qu'une consommation appropriée de certains médicaments ont été élaborés. Les indicateurs relatifs à une consommation appropriée sont décrits en fonction de la distribution de benzodiazépines à des personnes âgées. Nous avons découvert qu'une proportion appréciable des nouveaux utilisateurs de benzodiazépines (plus de 10 p. 100) reçoivent encore des ordonnances pour une version à action prolongée, ce qui semble témoigner d'une mauvaise utilisation potentielle. Les données permettent également de décrire certaines conséquences graves de la consommation de produits pharmaceutiques comme des décès, des fractures ainsi que des mesures cliniques fondées sur la population, le cas échéant.

Type
Articles
Copyright
Copyright © Canadian Association on Gerontology 2005

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

Ashton, H. (1995). Toxicity and adverse consequences of benzodiazepine use. Psychiatric Annals, 25, 158165.CrossRefGoogle Scholar
Berger, E. (2002). Attitudes to privacy, health records and interconnection: Implications for healthcare organizations. Hospital Quarterly, 5(4), 4045.Google ScholarPubMed
Brook, R.H., McGlynn, E.A., & Shekelle, P.G. (2000). Defining and measuring quality of care: A perspective from U.S. researchers. International Journal for Quality Health Care, 12(4), 281295.CrossRefGoogle ScholarPubMed
Burt, C.W. (2002). National trends in use of medications in office-based practices, 1998–1999. Health Affairs, 21(4), 206214.CrossRefGoogle Scholar
Chutka, D.S., Takahashi, P.Y., & Hoel, R.W. (2004). Inappropriate medications for elderly patients. Mayo Clinic Procedures, 79(1), 122139.CrossRefGoogle ScholarPubMed
Coambs, R., Jensen, P., Her, M.H., Ferguson, B.S., Jarry, J.L., Wong, J.S.W., & Abrahamsohn, R.V. (1995). Review of the scientific literature on the prevalence, consequences, and health costs of noncompliance and inappropriate use of prescription medication in Canada. Toronto: University of Toronto Press.Google Scholar
Commission on the Future of Health Care in Canada. (2002). Building on values: The future of health care in Canada — Final report. Ottawa: Queen's Printer.Google Scholar
Donabedian, A. (1980). Explorations in quality assessment and monitoring. Volume 1: The definition of quality and approaches to its assessment. Chicago: Health Administration Press.Google Scholar
Egan, M.P., Moride, Y.P., Wolfson, C.P., & Monette, J. (2000). Long-term continuous use of benzodiazepines by older adults in Quebec: Prevalence, incidence and risk factors. Journal of the American Geriatrics Society, 48, 811816.CrossRefGoogle ScholarPubMed
Eyles, J., Birch, S., Chambers, J., Hurley, J., & Hutchinson, B. (1993). A needs-based methodology for allocating health care resources in Ontario, Canada: Development and an application. Social Science and Medicine, 33, 489500.CrossRefGoogle Scholar
Fineberg, A.D. (2002). The Personal Information Protection and Electronic Documents Act: Physician prescription data and Canadian health system reviews. Health Law in Canada, 23(1), 110.Google ScholarPubMed
Futterman, R., Fillit, H., & Roglieri, J.L. (1997). Use of ineffective or unsafe medications among members of a Medicare HMO compared to individuals in a Medicare fee-for-service program. American Journal of Managed Care, 3, 569575.Google ScholarPubMed
George, M. (1994). Population projections for Canada, province and territories 1993–2016. Ottawa: Statistics Canada.Google Scholar
Grymonpre, R.E., Mitenko, P.A., Sitar, D.S., Aoki, F.Y., & Montgomery, P.R. (1988). Drug-associated hospital admissions in older medical patients. Journal of the American Geriatrics Society, 36, 10921098.CrossRefGoogle ScholarPubMed
Grymonpre, R.E., Sitar, D.S., Montgomery, P.R., Mitenko, P.A., & Aoki, F.Y. (1991). Prescribing patterns for older heavy drug users living in the community. Drug Intelligence and Clinical Pharmacy, 25, 186190.Google ScholarPubMed
Grymonpre, R.E., Williamson, D.A., Huynh, D.H., & Desilets, L.M. (1994). A community-based pharmaceutical care model for the elderly: Report on a pilot project. International Journal of Pharmacy Practice, (2), 229234.Google Scholar
Hanlon, J.T., & Lewis, J.K. (1995). Adverse drug reactions. In Delafuente, J. & Stewart, R.B. (Eds.), Therapeutics in the elderly. Cincinnati: Harvey Whitney Books, 212227.Google Scholar
Health Canada. (n.d.). Drug product database. Retrieved December 18, 2003, from http://www.hc-sc.gc.ca/hpb/drugs-dpd/Google Scholar
Health Care Committee Expert Advisory Panel on Alcohol and Drug Use. (1991). Guidelines for the prevention and management of benzodiazepine dependence. National Health and Medical Research Council. Canberra: Australian Government Publishing Service.Google Scholar
Ho, V., Hamilton, B.H., & Roos, L.L. (2000). Multiple approaches to assessing the effects of delays for hip fracture patients in the United States and Canada. Health Services Research, 34(7), 14991518.Google Scholar
Hogan, D.B., Maxwell, C.J., Fung, T.S., Ebly, E.M. (2003). Prevalence and potential consequences of benzodiazepine use in senior citizens: Results from the Canadian Study of Health and Aging. Canadian Journal of Clinical Pharmacology, 10(2), 7277.Google ScholarPubMed
Holbrook, A.M., Crowther, R., Lotter, A., Cheng, C., & King, D. (2000). The diagnosis and management of insomnia in clinical practice: A practical evidence-based approach. Canadian Medical Association Journal, 162, 216220.Google ScholarPubMed
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, D.C.: National Academy Press.Google Scholar
Kalvik, A., Isaac, P., & Janecek, E. (1996). Benzodiazepines: Treatment of anxiety, insomnia and alcohol withdrawal. Communications (March/April), 7–24.Google Scholar
Kassam, R., Farris, K.B., Burback, L., Volume, C.I., Cox, C.E., & Cave, A. (2001). Pharmaceutical care research and education project: Pharmacists' interventions. Journal of the American Pharmaceutical Association, 41(3), 401410.Google ScholarPubMed
Kaul, P., Saunders, L.D., Roos, L.L., Kephart, G., Ghali, W.A., Walld, R., & Warren, J. (2002). Trends in utilization of coronary artery bypass surgery and associated outcomes: Alberta, Manitoba, and Nova Scotia. American Journal of Medical Quality, 17(3), 103112.CrossRefGoogle ScholarPubMed
Kupfer, D.J., & Reynolds, C.F. (1997). Management of insomnia. New England Journal of Medicine, 336, 341346.CrossRefGoogle ScholarPubMed
Larson, E.B., Kukull, W.A., Buchner, D., & Reifler, B.V. (1987). Adverse drug reactions associated with global cognitive impairment in elderly persons. Annals of Internal Medicine, 107, 169173.CrossRefGoogle ScholarPubMed
Laupacis, A., Paterson, J.M., Mamdani, M., Rostom, A., & Anderson, G.M. (2003). Gaps in the evaluation and monitoring of new pharmaceuticals: Proposal for a different approach. Canadian Medical Association Journal, 169(11), 11701171.Google ScholarPubMed
Laurier, C., Moride, Y., & Kennedy, W.A. (2002). Health survey data on potentially inappropriate geriatric drug use. Annals of Pharmacotherapy, 36(3), 404409.CrossRefGoogle ScholarPubMed
Leslie, W.D., Metge, C.J., Kvern, B., Anderson, W.A., Manness, L.J., & Yuen, C.K. (2001). Population-based prevalence of clinical risk factors from the Maximizing Osteoporosis Management in Manitoba (MOMM) Project. Journal of Bone and Mineral Research, 16(Suppl. 1), S137604.Google Scholar
Leslie, W.D., Metge, C., & Ward, L. (2003). Establishing a regional bone density program: Lessons from the Manitoba experience. Journal of Clinical Densitometry, 6(3), 275282.CrossRefGoogle ScholarPubMed
Lipton, H.L., Bero, L.A., Bird, J.A., & McPhee, S.J. (1992). The impact of clinical pharmacists' consultations on physicians' geriatric drug prescribing: A randomized controlled trial. Medical Care, 30, 646658.CrossRefGoogle ScholarPubMed
Lipton, H.L., & Bird, J.A. (1993). Drug utilization review in ambulatory settings: State of the science and directions for outcomes research. Medical Care, 31, 10691082.CrossRefGoogle ScholarPubMed
Liu, G.G., & Christensen, D.B. (2002). The continuing challenge of inappropriate prescribing in the elderly: An update of the evidence. Journal of the American Pharmaceutical Association, 42(6), 847857.Google ScholarPubMed
Lohr, K.N., & Donaldson, M.S. (1990). Assuring quality of care for the elderly. Law Med Health Care, 18(3), 244253.CrossRefGoogle ScholarPubMed
MacWilliam, L. (1999). Premature mortality. Manitoba Centre for Health Policy, Concept Dictionary. Retrieved December 18, 2003, from http://www.umanitoba.ca/academic/centres/mchp/concept/dict/premature.mortality.htmlGoogle Scholar
Marks, J. (1988). Techniques of benzodiazepine withdrawal in clinical practice: A consensus workshop report. Medical Toxicology and Adverse Drug Experience, 3, 324333.Google ScholarPubMed
Martens, P.J., Brownell, M.D., & Kozyrskyj, A. (2002). The virtual classroom: A summary of child health indicators. Canadian Journal of Public Health, 93(Suppl. 2), S77S80.CrossRefGoogle ScholarPubMed
McGlynn, E.A., Asch, S.M., & Adams, J. (2003). The quality of health care delivered to adults in the United States. New England Journal of Medicine, 348(26), 26352645.CrossRefGoogle ScholarPubMed
Medication Working Group. (1988). Surgeon general's workshop. Health Promotion and Aging Proceedings. Washington, D.C.: U.S. Department of Health and Human Services.Google Scholar
Metge, C.J., Black, C., Peterson, S., & Kozyrskyj, A.L. (1999). The population's use of pharmaceuticals. Medical Care, 37, JS42JS59.CrossRefGoogle Scholar
Metge, C.J., Kozyrskyj, A., Dahl, M., Yogendran, M., & Roos, N.P. (2003). Pharmaceuticals: A focus on appropriate use. Winnipeg: Manitoba Centre for Health Policy.Google Scholar
Metge, C.J., Yogendran, M., Doupe, M., Katz, M., Kvern, B., & Thomson, G. (2002). Preparing administrative claims data for evaluation of limited use criteria: A case for nonsteroidal antiinflammatory drugs. Canadian Journal of Clinical Pharmacology, 9(1), 44.Google Scholar
Nowell, P.D., Mazumdar, S., Buysse, D.J., Dew, M.A., Reynolds, C.F., & Kupfer, D.J. (1997). Benzodiazepines and zolpidem for chronic insomnia: A meta-analysis of treatment efficacy. Journal of the American Medical Association, 278, 21702177.CrossRefGoogle ScholarPubMed
Quinn, K., Baker, M.J., & Evans, B. (1992). A population-wide profile of prescription drug use in Saskatchewan, 1989. Canadian Medical Association Journal, 146, 21772186.Google ScholarPubMed
Rawson, N.S.B. (2001). “Effectiveness” in the evaluation of new drugs: A misunderstood concept? Canadian Journal of Clinical Pharmacology, 8(2), 6162.Google ScholarPubMed
Reid, R., Roos, N.P., MacWilliam, L., Frohlich, N., & Black, C. (2002). Assessing population need using a claims-based ACG morbidity measure: A validation analysis in the province of Manitoba. Health Services Research, 37(5), 13451364.CrossRefGoogle Scholar
Roos, L.L., Sharp, S.M., & Wajda, A. (1989). Assessing data quality: A computerized approach. Social Science and Medicine, 28, 175182.CrossRefGoogle ScholarPubMed
Roos, L.L., Walld, R.K., Romano, P.S., & Roberecki, S. (1996). Short-term mortality after repair of hip fracture: Do Manitoba elderly do worse? Medical Care, 34, 310326.CrossRefGoogle ScholarPubMed
Roos, N.P., & Shapiro, E. (1999). Revisiting the Manitoba Centre for Health Policy and Evaluation and its population-based health information system. Medical Care, 37, JS10JS14.Google ScholarPubMed
Roos, N.P., Stranc, L., Peterson, S., Mitchell, L., Bogdanovic, B., & Shapiro, E. (2001). A look at home care in Manitoba. Retrieved December 18, 2003, from Manitoba Centre for Health Policy Web site: http://www.umanitoba.ca/centres/mchp/reports/reports_01/homecr.htmGoogle Scholar
Salzman, C. (1999). An 87-year-old woman taking a benzodiazepine. Journal of the American Medical Association, 281, 11211125.CrossRefGoogle ScholarPubMed
Salzman, C., Nobel, K., Glassman, R., Wolson, A., & Kelley, M. (1992). Cognitive improvement following benzodiazepine discontinuation in elderly nursing home residents. International Journal of Geriatric Psychiatry, 7, 8993.CrossRefGoogle Scholar
Sellors, J., Kaczorowski, J., Sellors, C., Dolovich, L., Woodward, C., Willan, A., Goeree, R., Cosby, R., Trim, K., Sebaldt, R., Howard, M., Hardcastle, L., & Poston, J. (2003). A randomized controlled trial of a pharmacist consultation program for family physicians and their elderly patients. Canadian Medical Association Journal, 169(1), 3031.Google ScholarPubMed
Shimp, L.A., Scione, F.J., Glazer, H.M., & Atwood, B.F. (1985). Potential medication-related problems in non-institutionalized elderly. Drug Intelligence and Clinical Pharmacy Drug, 19, 766772.CrossRefGoogle Scholar
Sketris, I.S., Metge, C.J., Blackburn, J., & MacCara, M.E. (2004). Using the World Health Organization (WHO) ATC and DDD system in a Canadian context. Drug Information Journal, 38(1), 1528.CrossRefGoogle Scholar
Spore, D.L., Mor, V., Larrat, P., Hawes, C., & Hiris, J. (1997). Inappropriate drug prescriptions for elderly residents of board and care facilities. American Journal of Public Health, 87, 404409.CrossRefGoogle ScholarPubMed
Starfield, B., Egbuonu, L., Farfel, M., Hutton, N., Joffe, A., & Wissow, L.S. (1985). The effectiveness of medical care: Validating medical wisdom. Baltimore: Johns Hopkins University Press.Google Scholar
Starfield, B., Weiner, J., Mumford, L., & Steinwachs, D. (1991). Ambulatory care groups: A categorization of diagnoses for research and management. Health Services Research, 26(1), 5374.Google ScholarPubMed
Statistics Canada. (2003). Population by sex and age group 2003. Retrieved December 18, 2003, from http://www.statcan.ca/eeenglish/Pgdb/dem0311.htmGoogle Scholar
Stuck, A.E., Beers, M.H., Steiner, A., Aronow, H.U., Rubenstein, L.Z., & Beck, J.C. (1994). Inappropriate medication use in community-residing older persons. Archives of Internal Medicine, 154, 21952200.CrossRefGoogle ScholarPubMed
Tamblyn, R.M., McLeod, P.J., Abrahamowicz, M., Monette, J., Gayton, D.C., Berkson, L., Dauphinee, W.D., Grad, R.M., Huang, A.R., Isaac, L.M. (1994). Questionable prescribing for elderly patients in Quebec. Canadian Medical Association Journal, 150, 18011809.Google ScholarPubMed
The treatment of sleep disorders of older people. (1990). National Institutes of Health, 8, 122.Google Scholar
Tognoni, G. (1983). Drug use and monitoring. In Holland, W.W. (Ed.), Evaluation of health care (p. 207). London: Oxford University Press.Google Scholar
Tu, K., Mamdani, M.M., Hux, J.E., & Tu, J.B. (2001). Progressive trends in the prevalence of benzodiazepine prescribing in older people in Ontario, Canada. Journal of the American Geriatrics Society, 49(10), 13411345.CrossRefGoogle ScholarPubMed
Willcox, S.M.M., Himmelstein, D.U., & Woolhandler, D. (1994). Inappropriate drug prescribing for the community-dwelling elderly. Journal of the American Medical Association, 272(July 27), 292296.CrossRefGoogle ScholarPubMed
Willison, D.J. (2003). Privacy and the secondary use of data for health research: Experience in Canada and suggested directions forward. Health Service Research and Policy, 8(Suppl. 1), S117S123.Google ScholarPubMed
Wolfson, M. (1994). Social proprioception: Measurement, data and information from a population health perspective. In Evans, R.G., Barer, M.L., & Marmor, T.R. (Eds.), Why are some people healthy and others not? The determinants of health of populations. New York: Aldine de Gruyter, 287316.CrossRefGoogle Scholar
World Health Organization. (1995). WHO's Centre for Drug Statistics Methodology: Guidelines for ATC classification and DDD assignment. Oslo: Author.Google Scholar
World Health Organization Collaborating Centre for Drug Statistics Methodology. (n.d.) Retrieved December 18, 2003, from http://www.whocc.no/atcddd/Google Scholar