(56) Drug Treatment in Older Patients According to Indicators of Potentially Rational Prescribing

Friday, August 26, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 387

Presenting Author(s)

Naldy Parodi L�pez
– University of Gothenburg, Gothenburg, Sweden

Co-Author(s)

Staffan A. Svensson, MD, PhD
– University of Gothenburg, Dept of Pharmacology, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
Susanna M. Wallerstedt
– University of Gothenburg, Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, G�teborg, V�stra G�talands l�n, Sweden

Background: Quality of drug treatment is commonly described using criteria for potentially inappropriate medications and/or potential prescribing omissions, but treatment according to indicators of potentially rational treatment in specific diagnoses is seldom reported.

Objectives: To investigate to what extent patients are being treated in accordance with indicators of potentially rational prescribing and the association of this with adequate drug treatment.

Methods: The drug treatment of 302 consecutive primary care patients (65–99 years of age, 59% female) was assessed by two general practitioners (GPs), independently and then in consensus, according to 19 Swedish indicators of potentially rational prescribing. The drug treatment was categorised as adequate if no action related to the patient´s medication was suggested by the GPs in consensus, and inadequate if some action was suggested, e.g. to change the drug treatment, order a laboratory test, or schedule an extra appointment.

Results: For a total of 223 (74%) patients, ≥1 indicator of potentially rational prescribing was fulfilled; 524 such instances were found (range: 0–7/patient). The top tree fulfilled indicators were: (i) angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker, and/or dihydropyridine calcium channel blocker, and/or thiazide diuretic in hypertension (169 (83%) out of 203 patients with this diagnosis); (ii) low-dose acetylsalicylic acid or clopidogrel or oral anticoagulant in ischemic heart disease (56 (92%) out of 61 patients); and (iii) statin in ischemic heart disease (43 (70%) out of 61 patients). For 2 (1%), 0 (0%), and 5 (8%) patients, respectively, for whom these indicators were not fulfilled, the GPs suggested to add the drug at issue. Crude logistic regression showed a negative association between having ≥1 fulfilled indicator of rational prescribing and adequate drug treatment (odds ratio: 0.53 (95% CI: 0.29–0.95)), but not the adjusted model including age, sex, and the number of drugs: 0.81 (0.42–1.58).

Conclusions: The majority of older primary care patients are treated according to at least one indicator of potentially rational treatment. When such treatment is absent, few cases required any related action. Having at least one fulfilled indicator was not associated with adequate drug treatment.