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HRB PhD Scholar Division of Population Health Sciences RCSI

Caitriona Cahir HRB PhD Scholar Division of Population Health Sciences RCSI. Measuring and Evaluating Indicators of Appropriate Prescribing in Older Populations Cahir C., Teeling M., Teljeur C., Bennett K., Fahey T.

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HRB PhD Scholar Division of Population Health Sciences RCSI

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  1. Caitriona Cahir HRB PhD ScholarDivision of Population Health SciencesRCSI Measuring and Evaluating Indicators of Appropriate Prescribing in Older PopulationsCahir C., Teeling M., Teljeur C., Bennett K., Fahey T. Potentially inappropriate prescribing and cost outcomes for older people: a national population study C Cahir, T Fahey, M Teeling, C Teljeur, J Feely, K Bennett HRB PhD ScholarDivision of Population Health SciencesRCSI

  2. Structure of Presentation • Brief background to study • Objectives • Methods • Results • Summary

  3. Background Prescribing for older people is a challenging process • Multi-morbidity • Physiological changes • Pharmacokinetics e.g. digoxin and toxicity • Pharmacodynamics e.g. benzodiazepines and falls • Cognitive impairment e.g. dementia

  4. Background • How do we measure appropriate prescribing in older people? • Appropriateness of prescribing – assessed by process or outcome measures that are implicit (judgment based) or explicit (criterion based) • Explicit process measures of potentially inappropriate prescribing (PIP) • Beers criteria (International) • STOPP screening tool (Irish & UK)

  5. Objectives • Estimate the prevalence of PIP in a national Irish older population in 2007 using Beers and STOPP criteria • Investigate the association between PIP, number of medications, gender and age • Establish the associated cost of PIP

  6. Method • Retrospective national population study (aged ≥70 years) using the HSE-PCRS for a one year period (2007) (n=338,801) • Health Services Executive Primary Care Reimbursement Services (HSE-PCRS) – prescription claims, WHO ATC, gender, age • Beers (independent of diagnosis) and thirty STOPP indicators applied

  7. RESULTS OVERALL

  8. PIP Overall Prevalence Rates(n=338,801)

  9. PIP and Number of Medications • Strong association between PIP and the number of different medications • Beers (10 drugs vs none) OR=9 • STOPP (10 drugs vs none) OR=50

  10. Association between the number of different medications and PIP (STOPP) in 2007 * Linear and quadratic trend p<0.0001

  11. PIP and Gender and Age • PIP more likely in females vs males • Beers (1.58, 1.56 to 1.60) • STOPP (1.10, 1.08 to 1.12) • PIP more likely in those aged >75yrs vs. 70-74yrs • Beers (1.22, 1.20 to 1.24) • STOPP (1.28, 1.26 to 1.30) • Additionally adjusting for number of medications • Beers Gender (1.46, 1.44 to 1.48) • STOPP Gender (0.91, 0.90 to 0.93) • Beers Age (0.98, 0.97 to 1.00) • STOPP Age (0.95, 0.93 to 0.96)

  12. RESULTS INDIVIDUAL CRITERIA

  13. Beers Adjusted Analysis 20075 highest prevalence rates per drug class (n=338,801)

  14. STOPP Adjusted Analysis 20075 highest prevalence rates per drug class (n=338,801)

  15. RESULTS COSTS

  16. Overall Costs • Beers maximum costs • Net ingredient cost €10,712,129 • Total expenditure €15,478,526 • STOPP maximum costs • Net ingredient cost €38,664,640 • Total expenditure €45,631,319

  17. Beers Cost Analysis 2007 Highest costs as a proportion of overall costs (NIC= €10,712,129 and Total Exp=€15,478,526)

  18. STOPP Cost Analysis 2007 Highest costs as a proportion of overall costs (NIC=€38,664,640 and Total Exp= €45,631,319) * Adjusted for claimants receiving the same medication per more than one criteria

  19. Summary • High prevalence of PIP in older populations in Ireland per Beers and STOPP criteria • The greater the number of medications the more likely PIP • Differences in prevalence rates across gender and age groups • Significant costs

  20. Acknowledgements • Dr Stephen Byrne, School of Pharmacy and Dr Denis O’Mahony,Department of Medicine, UCC for developing the STOPP criteria • Health Services Executive Primary Care Reimbursement Services (HSE-PCRS) • The Health Services Research Institute - the Irish Health Research Board’s (HRB) Cross-Institution PhD Scholars Programme in Health Services Research • HRB Centre for Primary Care Research

  21. Duplicates and PPIs • Duplicates – 4.78% • Two concurrent NSAIDs (2.22%) Diclofenac with glucosamine or nimesulide • Two concurrent opioids (1.24%) Tramadol with codeine and morphine • PPIs • Co-prescriptions (asp, warfarin, NSAID) • Duration and dosage

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