Potentially inappropriate prescribing (PIP) is the use of medication where the potential harms of prescribing a medication are likely to outweigh the benefits. It has been recognised as an important factor in the care of older persons (over-65s); in this group it is associated with poorer clinical outcomes and lower patient reported quality of life.
In older persons PIP is common and has shown to be associated with being prescribed multiple medications and having multiple long-term medical conditions. However, being prescribed multiple medications and having multiple long-term conditions is also common in middle-aged adults.
Studies in countries other than the UK have indicated that PIP is also common in middle-aged adults. It has been linked to an increased chance of having adverse reactions to medication, in hospitalised patients in this age group.
However, the prevalence of PIP in middle-aged adults in the UK is not known and its implications for risk of death, health care usage and costs have yet to be explored. The aim of this study will be to assess how common PIP is in middle-aged adults using GP records and assess its link with risk of death, GP appointments, outpatient appointments, and hospital admission.
Potentially inappropriate prescribing (PIP) is prescribing where the risk of harms outweigh the potential benefits
This cohort study aims to examine whether PIP in middle-aged adults (45-64 years old) is associated with adverse health outcomes and increased healthcare utilisation. It will determine the prevalence of PIP in a nationally representative sample and examine the relationship between PIP in middle aged adults with healthcare utilisation, and all-cause mortality.
The study population will include all patients fulfilling the eligibility criteria who are registered in CPRD (Clinical Practice Research Datalink) practices in England consenting to data linkage for, Hospital Episode Statistics Admitted Patient Care (HES-APC) dataset, and death registration data from the Office of National statistics (ONS). Participants will include all patients aged 45-64 years in the year prior to the index date of the study.
The exposure will be defined as any episode of PIP, defined by the PROMPT (Prescribing Optimally in Middle-aged People’s Treatments) criteria, in the year prior to the index date of the study. All Outcomes will be measured in the year following the index date of the study. The Primary outcome will be all-cause mortality, with secondary outcomes being the number of GP appointments, and number of hospital admissions. The prevalence of PIP will also be reported.
The number of GP appointments will be assessed using CPRD data. Hospital admissions will be assessed using Hospital Episode Statistics. All-cause mortality will be assessed using Office of National Statistics data.
A cox proportional hazard model will be used to examine the association of PIP with all-cause mortality. Multi-level logistic regression will be used to examine the association of PIP with GP appointments and hospital admissions.
The findings from this research will be used to inform the development and implementation of medicines optimisation interventions, to improve prescribing quality and patient safety.
In the year prior to the index date of the study exposure to potentially inappropriate prescribing will be defined. Then in the year following we will report outcomes.
Primary Outcome:
All-cause mortality
Secondary Outcomes:
Number of GP appointments
Number of Hospital admissions
Ian Douglas - Chief Investigator - London School of Hygiene & Tropical Medicine ( LSHTM )
Michael Naughton - Corresponding Applicant - King's College London (KCL)
Ian Douglas - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Mariam Molokhia - Collaborator - King's College London (KCL)
Patrick Redmond - Collaborator - King's College London (KCL)
Rohini Mathur - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Rohini Mathur - Collaborator - Queen Mary University of London
HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation