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Potentially inapropriate prescriptions for older patients in long-term care / RANCOURT, Carol ; MOISAN, Jocelyne ; BAILLARGEON, Lucie ; VERREAULT, René ; LAURIN, Danielle ; GREGOIRE, Jean-Pierre.
BMC Geriatrics, 2004, vol. 4 (9), 31 p.

http://www.biomedcentral.com/content/pdf/1471-2318-4-9.pdf (08-11-2004)
Copyright : La reproduction de ce document à des fins non commerciales est autorisée à condition que la source soit dûment mentionnée.

Lieux géographiques
: Quebec Greater Area, Quebec (province), Canada

Descriptors
:
Retrospective studies
Drug consumption
Patient compliance
Utilization
Long-term care


Résumé :

La question de l'utilisation non appropriée des médicaments par les personnes âgées est d'une très grande importance. Cette étude analyse la prévalence des prescriptions potentiellement non appropriées dans les soins de longue durée dans la région de Québec. L'échantillon à l'étude est composé de 2 633 individus, âgés de 65 ans et plus, résidant des les établissements de soins de longue durée pour une durée moyenne de 8,5 ans. L'étude démontre qu'il faut prendre cette question au sérieux et que l'utilisation d'une liste de critères explicites peut aider à identifier les principales questions et à prioriser les interventions pour améliorer la qualité des soins et la sécurité des patients.

Background
Inappropriate medication use is a major healthcare issue for the elderly population. This study explored the prevalence of potentially inappropriate prescriptions (PIPs) in longterm care in metropolitan Quebec.
Methods
A cross sectional chart review of 2,633 long-term care older patients of the Quebec City area was performed. An explicit criteria list for PIPs was developed based on the literature and validated by a modified Delphi method. Medication orders were reviewed to describe prescribing patterns and to determine the prevalence of PIPs. A multivariate analysis was performed to identify predictors of PIPs.
Results
Almost all residents (94.0%) were receiving one or more prescribed medication; on average patients had 4.8 prescribed medications. A majority (54.7%) of treated patients had a potentially inappropriate prescription (PIP). Most common PIPs were drug interactions (33.9% of treated patients), followed by potentially inappropriate duration (23.6%), potentially inappropriate medication (14.7%) and potentially inappropriate dosage (9.6%). PIPs were most frequent for medications of the central nervous system (10.8% of prescribed medication). The likelihood of PIP increased significantly as the number of drugs prescribed increased (odds ratio [OR]: 1.38, 95% confidence interval 3 [CI]: 1.33 - 1.43) and with the length of stay (OR: 1.78, CI: 1.43 - 2.20). On the other hand, the risk of receiving a PIP decreased with age.
Conclusion
Potentially inappropriate prescribing is a serious problem in the highly medicated longterm care population in metropolitan Quebec. Use of explicit criteria lists may help identify the most critical issues and prioritize interventions to improve quality of care and patient safety.

Language : Anglais
Doc n° : 18068
NumRec : 1806803
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