Patient factors associated with new prescribing of potentially inappropriate medications in multimorbid US older adults using multiple medications

Abstract

Abstract Background The use of potentially inappropriate medications (PIMs) is common in older adults and is associated with potential negative consequences, such as falls and cognitive decline. Our objective was to investigate measurable patient factors associated with new outpatient prescribing of potentially inappropriate medications in older multimorbid adults already using multiple medications. Methods In this retrospective US cohort study, we used linked Medicare pharmacy and medical claims and electronic health record data from a large healthcare system in Massachusetts between 2007 and 2014. We identified patients aged ≥65 years with an office visit who had not been prescribed or used a PIM in the prior 180 days. PIMs were defined using 2019 Beers criteria of the American Geriatrics Society. To specifically evaluate factors in patients with polypharmacy and multimorbidity, we selected those who filled medications for ≥90 days (i.e., chronic use) from ≥5 pharmaceutical classes in the prior 180 days and had ≥2 chronic conditions. Multivariable Cox regression analysis was used to estimate the association between baseline demographic and clinical characteristics on the probability of being prescribed a PIM in the 90-day follow-up period. Results In total, we identified 17,912 patients aged ≥65 years with multimorbidity and polypharmacy who were naïve to a PIM in the prior 180 days. Of those, 10,497 (58.6%) were female, and mean age was 78 (SD = 7.5). On average, patients had 5.1 (SD = 2.3) chronic conditions and previously filled 6.1 (SD = 1.4) chronic medications. In total, 447 patients (2.5%) were prescribed a PIM during the 90-day follow-up. Male sex (adjusted hazard ratio (HR) = 1.29; 95%CI: 1.06–1.57), age (≥85 years: HR = 0.75, 95%CI: 0.56–0.99, 75–84 years: HR = 0.87, 95%CI: 0.71–1.07; reference: 65–74 years), ambulatory visits (18–29 visits: HR = 1.42, 95%CI: 1.06–1.92; ≥30 visits: HR = 2.12, 95%CI: 1.53–2.95; reference: ≤9 visits), number of prescribing orders (HR = 1.02, 95%CI: 1.01–1.02 per 1-unit increase), and heart failure (HR = 1.38, 95%CI: 1.07–1.78) were independently associated with being newly prescribed a PIM. Conclusion Several demographic and clinical characteristics, including factors suggesting lack of care coordination and increased clinical complexity, were found to be associated with the new prescribing of potentially inappropriate medications. This knowledge could inform the design of interventions and policies to optimize pharmacotherapy for these patients.

Keywords

• Multimorbidity
• Polypharmacy
• Potentially inappropriate prescribing