Older people are more likely to be prescribed multiple medications, have multiple chronic conditions and experience an increasing number of transitions of care (e.g. hospitalisation). Polypharmacy (the prescribing of multiple medications) is increasingly common and patients are now routinely prescribed medication long term for the management of chronic conditions. In the UK, General Practitioners usually coordinate the prescribing of patients medications.
With the rise in polypharmacy the appropriateness of prescribed medication (e.g. drug/disease interactions; increased side-effects profile) has come under increased scrutiny. Potentially inappropriate prescribing (PIP) is common among older people and is associated with adverse outcomes (hospitalisation, adverse drug events and poorer quality of life).
It is less clear however how hospitalisation impacts on PIP prevalence upon discharge. The aim of this study is to examine the GP and hospitalisation records of older patients to determine the impact of hospitalisation on the appropriateness of prescribing in the GP record.
Background and rationale
Older patients are more likely to be prescribed multiple medications, have multiple chronic conditions, and experience increasing number of transitions of care. A recent meta-analysis reported potentially inappropriate prescribings (PIP) impact on ADEs, health related quality of life and hospitalisation. It is less clear what impact transitions of care have in generating PIP post discharge.
Objectives
To examine the association between hospital admission and potentially inappropriate prescribing, and to compare the prevalence of potentially inappropriate prescribing before and after hospitalisation
Design:
A retrospective cohort study utilising Hospital Episodes Statistics and CPRD. A multi-level logistic regression analysis will be performed to examine the association between PIP and hospitalisation comparing those experiencing hospitalisations and those not hospitalised.
The outcome is prevalence of PIP assessed using a subset (n=45) of criteria from the full Screening Tool for Older Persons Prescription (STOPP) version 2 (7,8).
For each patient, we will calculate the total number and dates of first occurrence of distinct potentially inappropriate prescribing criteria. We will report these as recurrent events (e.g. number of distinct potentially inappropriate prescribing criteria met) and as a dichotomous variable (at least one potentially inappropriate prescription).
STOPP has been used extensively in research as a process of care measure. It has been associated with ADEs, emergency department visits and hospital admissions (912). The use of a subset applied to a database is based on our previously published work based on likely availability of drug and disease coding information (e.g. absence of clinical indication) (2,8,11).
Patrick Redmond - Chief Investigator - King's College London (KCL)
Patrick Redmond - Corresponding Applicant - King's College London (KCL)
Mariam Molokhia - Collaborator - King's College London (KCL)
Martin Gulliford - Collaborator - King's College London (KCL)
Vibhore Prasad - Collaborator - King's College London (KCL)
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation