Lindsey Harrison1, Emilie O'Connor2, Chunfa Jie3, Thomas Benzoni4, Catherine Hackett Renner5, Ryan McCracken4. 1. UnityPoint Health, Office of Research, Des Moines, IA, United States of America.; Des Moines University College of Osteopathic Medicine, Des Moines, IA, United States of America.. Electronic address: lindsey.harrison@unitypoint.org. 2. UnityPoint Health, Office of Research, Des Moines, IA, United States of America.; Des Moines University College of Osteopathic Medicine, Des Moines, IA, United States of America. 3. Des Moines University College of Osteopathic Medicine, Des Moines, IA, United States of America. 4. UnityPoint Health, Department of Emergency Medicine, Des Moines, IA, United States of America. 5. UnityPoint Health, Office of Research, Des Moines, IA, United States of America.
Abstract
STUDY OBJECTIVE: To investigate the frequency of Beers Criteria (BC) medication and opioid use in patients age 65 years and older arriving in the Emergency Department. METHODS: We performed a retrospective observational study of a convenience sample of 400 patients, age 65 years and older, arriving to and discharged solely from the Emergency Department. We examined 400 sequential patient charts with visit dates April-July 2017, for the presence of a Beers Criteria medication or opioid prescription. We also examined each chart for nine specific chief complaints, including return visits and subsequent admissions. RESULTS: Of the 400 patients included in this study, 304 patients (76%; 95% confidence interval [CI] 72% to 80%) had at least 1 prescription at the index ED visit for an "avoid" or "use with caution" Beers Criteria medication. Of these patients, 194 (64%; 95% CI 58% to 69%) had ≥2 Beers medication prescriptions and 122 patients (40%; 95% CI 35% to 46%) had ≥3 Beers medication prescriptions. We found no difference in the number of patients with a chief complaint of interest between the BC medication list (28%) and lacking a BC medication (29%) (p-value = 1). No patients returned in the next 7 days for a medication-related complaint. CONCLUSION: The results of this study call into question the routine application of lists without high-quality evidence to critique the prescribing of certain medications. Further patient-oriented study of the relevance of the Beers Criteria list, especially in light of the changed face of medication profiles and populations, is called for.
STUDY OBJECTIVE: To investigate the frequency of Beers Criteria (BC) medication and opioid use in patients age 65 years and older arriving in the Emergency Department. METHODS: We performed a retrospective observational study of a convenience sample of 400 patients, age 65 years and older, arriving to and discharged solely from the Emergency Department. We examined 400 sequential patient charts with visit dates April-July 2017, for the presence of a Beers Criteria medication or opioid prescription. We also examined each chart for nine specific chief complaints, including return visits and subsequent admissions. RESULTS: Of the 400 patients included in this study, 304 patients (76%; 95% confidence interval [CI] 72% to 80%) had at least 1 prescription at the index ED visit for an "avoid" or "use with caution" Beers Criteria medication. Of these patients, 194 (64%; 95% CI 58% to 69%) had ≥2 Beers medication prescriptions and 122 patients (40%; 95% CI 35% to 46%) had ≥3 Beers medication prescriptions. We found no difference in the number of patients with a chief complaint of interest between the BC medication list (28%) and lacking a BC medication (29%) (p-value = 1). No patients returned in the next 7 days for a medication-related complaint. CONCLUSION: The results of this study call into question the routine application of lists without high-quality evidence to critique the prescribing of certain medications. Further patient-oriented study of the relevance of the Beers Criteria list, especially in light of the changed face of medication profiles and populations, is called for.