Andreas D Meid1, Renate Quinzler1, Andreas Groll2, Beate Wild3, Kai-Uwe Saum4, Ben Schöttker4, Dirk Heider5, Hans-Helmut König5, Hermann Brenner4,6, Walter E Haefeli7. 1. Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. 2. Department of Mathematics, Ludwig-Maximilians-University Munich, Theresienstr. 39, 80333, Munich, Germany. 3. Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. 4. Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany. 5. Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 6. Network Aging Research, University of Heidelberg, Bergheimer Straße 20, 69120, Heidelberg, Germany. 7. Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. walter.emil.haefeli@med.uni-heidelberg.de.
Abstract
PURPOSE: We investigated the factors promoting prescribing omissions (medication underuse) in long-term medical care and the impact of withholding indicated medications on quality of life. METHODS: In a population-based cohort study of older ambulatory patients (ESTHER), we collected data with sequential questionnaires from participants and from their GPs. Concurrently, in two consecutive home visits, trained study physicians performed comprehensive geriatric assessments and recorded all medicines currently taken. Each patient's medication was screened for underuse using the START-2 criteria. RESULTS: Medication underuse (absence of ≥1 indicated medication) was present in 70.3 and 73.2 % of 989 participants at two consecutive home visit assessments, respectively. Following variable selection accounting for subject-specific heterogeneity over time, multivariate results revealed that more drugs (odds ratio with 95 % confidence intervals: 0.83 [0.78;0.87] per drug) and better cognitive status (0.93 [0.87;0.99] per point on the MMSE scale) were preventive factors, while worse self-reported health status (1.33 [1.05;1.67] per point on an 5-point scale) and increasing frequency of GP consultations (1.07 [1.00;1.15] per visit within the preceding 3 months) were positively associated with medication underuse. An increase in omitted medications over time was associated with worse quality of life as determined on the EuroQuol EQ-Vas and EQ-5D scales. CONCLUSION: In addition to general and physician-related factors, also patient-related aspects, such as individual health appraisal, were associated with medication underuse. Because withholding indicated drugs was associated with substantially reduced quality of life, controlled intervention studies are necessary to confirm the notion that pharmacological appropriateness improves personal wellbeing.
PURPOSE: We investigated the factors promoting prescribing omissions (medication underuse) in long-term medical care and the impact of withholding indicated medications on quality of life. METHODS: In a population-based cohort study of older ambulatory patients (ESTHER), we collected data with sequential questionnaires from participants and from their GPs. Concurrently, in two consecutive home visits, trained study physicians performed comprehensive geriatric assessments and recorded all medicines currently taken. Each patient's medication was screened for underuse using the START-2 criteria. RESULTS: Medication underuse (absence of ≥1 indicated medication) was present in 70.3 and 73.2 % of 989 participants at two consecutive home visit assessments, respectively. Following variable selection accounting for subject-specific heterogeneity over time, multivariate results revealed that more drugs (odds ratio with 95 % confidence intervals: 0.83 [0.78;0.87] per drug) and better cognitive status (0.93 [0.87;0.99] per point on the MMSE scale) were preventive factors, while worse self-reported health status (1.33 [1.05;1.67] per point on an 5-point scale) and increasing frequency of GP consultations (1.07 [1.00;1.15] per visit within the preceding 3 months) were positively associated with medication underuse. An increase in omitted medications over time was associated with worse quality of life as determined on the EuroQuol EQ-Vas and EQ-5D scales. CONCLUSION: In addition to general and physician-related factors, also patient-related aspects, such as individual health appraisal, were associated with medication underuse. Because withholding indicated drugs was associated with substantially reduced quality of life, controlled intervention studies are necessary to confirm the notion that pharmacological appropriateness improves personal wellbeing.
Entities:
Keywords:
Elderly; Inappropriate prescribing; Medication underuse; Outpatients; Quality of life
Authors: Michael A Steinman; C Seth Landefeld; Gary E Rosenthal; Daniel Berthenthal; Saunak Sen; Peter J Kaboli Journal: J Am Geriatr Soc Date: 2006-10 Impact factor: 5.562
Authors: Tischa J M van der Cammen; Chakravarthi Rajkumar; Graziano Onder; Carolyn S Sterke; Mirko Petrovic Journal: Age Ageing Date: 2013-11-12 Impact factor: 10.668
Authors: Janine A Cooper; Cathal A Cadogan; Susan M Patterson; Ngaire Kerse; Marie C Bradley; Cristín Ryan; Carmel M Hughes Journal: BMJ Open Date: 2015-12-09 Impact factor: 2.692
Authors: Fiona von Buedingen; Marc S Hammer; Andreas D Meid; Walter E Müller; Ferdinand M Gerlach; Christiane Muth Journal: BMC Fam Pract Date: 2018-07-28 Impact factor: 2.497
Authors: Christiane Muth; Lorenz Uhlmann; Walter E Haefeli; Justine Rochon; Marjan van den Akker; Rafael Perera; Corina Güthlin; Martin Beyer; Frank Oswald; Jose Maria Valderas; J André Knottnerus; Ferdinand M Gerlach; Sebastian Harder Journal: BMJ Open Date: 2018-02-24 Impact factor: 2.692