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Patient Age as a Factor in Drug Prescribing Practices

Published online by Cambridge University Press:  29 November 2010

Joyce Ann Ferguson
Joyce Ann Ferguson
Affiliation:
University of Oxford
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Abstract

This study utilized 1985 United States National Ambulatory Medical Care Survey data to explore the relationship between the drug prescribing phenomenon, measured by inappropriate prescribing and by prescription volume, and patient age. Inappropriate prescribing was relabelled potentially undesirable prescribing because limited medico-social patient information restricting circumstantial knowledge could result in an oversimplified and unduly critical judgment of prescribing. Categories of potentially undesirable prescribing were developed: 1) more than one drug in the same class; 2) drug classes not to be combined; 3) drugs serving sub-optimal treatment; and 4) drugs and diagnoses not to be combined. Of 67 different generic drugs representing 13 drug classes studied, 242 products were prescribed to the sample of 33,574 patients age 45+ years. Potentially undesirable prescribing was found to be a common problem regardless of type of medical practice and the sex of the patient: it is related to the age of the patient. The adverse effect of visiting a general practitioner is greater for older patients; and the adverse effect of attending a practice in a non-metropolitan area is larger for the older patients.

Résumé

Cette étude, qui repose sur les données tirées du sondage national effectué aux Etats-Unis en 1985 sur les soins médicaux ambulatoires, examine le rapport entre l'âge du patient et la prescription de médicaments, mesurée selon la nature inappropriée des ordonnances et leur volume. On a substitué l'expression “ordonnance potentiellement indésirable” à l'expression “ordonnance inappropriée” parce que le fait de disposer de renseignements d'ordre médico-social limités sur le patient, et done d'une connaissance insuffisante de ses antécédents risque, au moment de prescrire un médicament, de rendre le jugement indûment simplifié et critique. Les catégories suivantes ont été établies en ce qui concerne la prescription potentiellement indésirable: 1) plus d'un médicament appartenant à la même catégorie, 2) des catégories de médicaments à ne pas combiner, 3) des medicaments n'assurant qu'un traitement suboptimal et 4) des médicaments et des diagnostics incompatibles. Sur 67 médicaments génériques represéntant 13 catégories de médicaments étudiées, 242 produits ont été prescrits à un échantillon de 33 574 patients âgés de 45 ans ou plus. On a constaté que l'ordonnance potentiellement indésirable était un problème courant quelle que soit la discipline médicale et le sexe du patient, mais qu'il existait un rapport avec l'âge du patient. La consultation d'un médicin généraliste a un effet défavorable plus marque chez les patients âgés, et il en est de même pour la consultation d'un medecin dans les régions non métropolitaines pour ce groupe de personnes.

Keywords

Inappropriate PrescribingDrugsPatient AgePrescription Volume
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 9 , Issue 3 , Autumn/automne 1990 , pp. 278 - 295
Copyright
Copyright © Canadian Association on Gerontology 1990

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