Steven simon 40

9th Annual HMO Research Network Conference Rates of Potentially Inappropriate Medication Use Among Elderly persons in the United States, 2000-2001 Steven R Simon, MD, MPH, Department of Ambulatory Care and Prevention,
Harvard Medical School and Harvard Pilgrim Health Care
Jerry H Gurwitz, MD, Meyers Primary Care Institute, Fallon Foundation and
University of Massachusetts Medical School
Arnold Chan, MD, ScD, Channing Laboratory, Brigham and Women’s Hospital
Stephen B Soumerai, ScD, Department of Ambulatory Care and Prevention,
Harvard Medical School and Harvard Pilgrim Health Care
Adrianne C Feldstein, MD, Center for Health Research, Kaiser Permantente Northwest
Susan E Andrade, ScD, Meyers Primary Care Institute, Fallon Foundation and
University of Massachusetts Medical School
Jennifer Elston-Lafata, PhD, Henry Ford Health Systems
Anita Wagner, PharmD, MPH, Department of Ambulatory Care and Prevention,
Harvard Medical School and Harvard Pilgrim Health Care
Richard Platt, MD, Department of Ambulatory Care and Prevention, Harvard Medical School and
Harvard Pilgrim Health Care; and Channing Laboratory, Brigham and Women’s Hospital
Background: In 1996, 21.3% of community-dwelling elderly persons in the US received at least 1 of 33
potentially inappropriate medications, as defined by explicit criteria. We sought to determine the prevalence
of potentially inappropriate medication use among elderly persons enrolled in managed care plans in the
United States in 2000-01.
Methods: We used automated medication dispensing data from 10 HMOs across the US to measure
prevalence of use, as defined by any dispensing, of 33 potentially inappropriate medications from January 1,
2000 through June 30, 2001. A total of 156,843 members age 65 years or older comprise the sample.
Results: In 2000-2001, 28.8% (95% confidence interval, 28.6%-29.0%) of elderly members of 10 health
maintenance organizations received at least 1 of 33 potentially inappropriate medications. This rate ranged
from 24% to 37% across 10 HMOs. Approximately 5% of elderly patients received at least 1 of the 11
medications classified by expert panels as “always avoid”; 13% received at least 1 of the 8 medications that
would rarely be considered appropriate; and 17% received at least 1 of the 14 medications that have some
indications but are often misused. Overall, rates of use of these medications were higher among women
(32%) than among men (25%). At least one percent of elderly members received belladonna alkaloids (2%),
dicyclomine (1%), hyoscyamine (1%) or meperidine (1%), each of which has been classified by multiple
expert panels as always inappropriate in patients aged 65 years or older. Seven percent of elderly members
received propoxyphene, an analgesic medication considered rarely appropriate in the elderly and a drug that
has a long history of limited efficacy and potential for toxicity.
Conclusions: Recent rates of potentially inappropriate medication use among elderly members in HMOs
mirror rates among community-dwelling elderly persons in 1996, the most recent nationally representative
data available. Use of potentially inappropriate medications may not always indicate a prescribing error, and
the relationship between use of potentially inappropriate medications and adverse outcomes remains
unproven. Nevertheless, a variety of interventions may be considered to reduce the use of these medications
in managed care settings.

Source: http://www.hmornmeeting.org/archives/2003/2003abst/03_pa_40.pdf