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Study documents the prescribing of potentially harmful drugs to elderly outpatients prescribed multiple drugs

Nearly 3 percent of elderly outpatient visits in which doctors prescribe one or more medications include prescriptions for drugs that are inappropriate for patients with certain conditions, according to a new study. For example, about 4 percent of patients with benign prostatic hypertrophy were prescribed at least one of six drugs that should be avoided in men with that condition, and 6 percent of patients with peptic ulcers were prescribed aspirin, which can cause gastrointestinal bleeding among these patients.

The study also highlighted drug combinations that pose the most serious threats to older patients. Nearly 7 percent of visits with a prescription for warfarin also included prescriptions for other drugs that could have harmful drug interactions. Overall, 0.76 percent of visits involving two or more prescriptions had at least one of six potentially inappropriate drug-drug combinations. The odds of having an inappropriate drug-drug combination in patients prescribed two or more drugs increased nearly two-fold with each prescribed drug added. The odds of having an inappropriate drug-disease combination in patients who had at least one drug prescribed increased 1.62 times with each prescribed drug added.

These results underscore the importance of proper management and monitoring of polypharmacy in older patients, notes Chunliu Zhan, M.D., Ph.D., of the Agency for Healthcare Research and Quality. These findings were based on analysis of the 1995-2000 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, which included 70,203 outpatient visits by patients aged 65 and older. Of these, 44 percent had at least two medications prescribed or represcribed.

More details are in "Suboptimal prescribing in elderly outpatients: Potentially harmful drug-drug and drug-disease combinations," by Dr. Zhan, Rosaly Correa-de-Araujo, M.D., M.Sc., Ph.D., Arlene S. Bierman, M.D., M.S., and others, in the February 2005 Journal of the American Geriatrics Society 53, pp. 262-267. Reprints (AHRQ Publication No. 05-R041) are available from the AHRQ Publications Clearinghouse.

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