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Associate Professor, Department of Medicine, Research Faculty, Landon Center on Aging, School of Medicine, University of Kansas, Kansas City, KS
Assistant Professor, Department of Medicine, School of Medicine, University of Kansas, Kansas City
Assistant Professor, Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
Associate Professor of Pharmacoeconomics, Department of Pharmacy Practice, School of Pharmacy, University of Kansas, Lawrence, KS; Associate Scientist, Landon Center on Aging, School of Medicine, University of Kansas, Kansas City
Assistant Professor of Pharmacy Practice, School of Pharmacy, University of Kansas, Kansas City
Reprints: Dr. Rigler, Landon Center on Aging, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160-7117, fax 913/588-1201, srigler{at}kumc.edu
BACKGROUND: Potentially inappropriate medication use is a serious quality concern, especially when it occurs in more vulnerable older adults or for extended durations.
OBJECTIVE: To characterize patterns of inappropriate medication use and duration among 3 cohorts with differing health status.
METHODS: We identified unconditionally inappropriate drug use, using
Beers 1997 criteria, among 3185 older Kansas Medicaid beneficiaries. Claims
from May 2000 to April 2001 provided data for 3 cohorts: nursing facility (NF)
residents, recipients of home- and community-based services through the Frail
Elderly (FE) program, and persons with neither NF/FE care (Ambulatory).
Duration, categorized as short-term (
1 month's supply), extended
(>1–9 mo), or chronic (>9–12 mo), was determined for each
drug and cohort. Drug–disease associations were explored.
RESULTS: Any inappropriate medication use occurred in 21%, 48%, and 38% of Ambulatory, FE, and NF cohorts, respectively. Inappropriate analgesics, antihistamines, antidepressants, muscle relaxants, and oxybutynin were most common, but prevalence and duration varied by cohort. Short-term analgesic and antihistamine use was common. FE cohort members had the highest use rates for all drugs. The NF cohort had less antidepressant and muscle relaxant use. Drug–disease associations were noted for amitriptyline use in diabetes mellitus, propoxyphene use in musculoskeletal and upper gastrointestinal conditions, and muscle relaxant use in musculoskeletal conditions.
CONCLUSIONS: Cross-sectional, one-year prevalence figures are comprised of both short- and long-term use that varies by drug and cohort. NF residence is associated with reduced use of drugs scrutinized during mandated medication review. Relevant diseases are associated with specific inappropriate prescribing. Future efforts should target extended and chronic duration of use and persons at highest risk for adverse effects, including recipients of home- and community-based care.
Key Words: geriatrics: Medicaid, prescribing patterns
Published Online, May 31, 2005. www.theannals.com, DOI 10.1345/aph.1E581
This article has been cited by other articles:
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  G. E Alkema, K. H Wilber, W J. Simmons, S. M Enguidanos, and D. Frey Prevalence of Potential Medication Problems Among Dually Eligible Older Adults in Medicaid Waiver Services Ann. Pharmacother., December 1, 2007; 41(12): 1971 - 1978. [Abstract] [Full Text] [PDF]
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