Research Activities, January 2010: Patient Safety and Quality: Criteria used to identify “drugs to avoid” in the elderly are not very accurate

Patient Safety and Quality
Criteria used to identify "drugs to avoid" in the elderly are not very accurate

A number of drugs are not considered appropriate for elderly patients due to their side effects, limited efficacy, or both. Lists of these drugs, called "drugs-to-avoid criteria," are used as markers of prescribing problems for elderly patients. In fact, versions of these criteria are required by the Centers for Medicare and Medicaid Services for use in nursing homes. Yet these criteria are limited in their ability to identify inappropriate drugs, reveals a new study.

Researchers from the University of Iowa Center for Education and Research on Therapeutics (CERT) obtained information from medical records and patient interviews on 256 elderly outpatients taking at least 5 different medications. Two versions of drugs-to-avoid criteria were used to determine which drugs being taken by participants were considered inappropriate.

A separate team of a physician and a pharmacist interviewed each patient, reviewed their medical records, and provided an expert opinion as to which drugs they felt were inappropriate. The 256 patients participating in the study were using a total of 3,678 medications. Based on their analysis, the physician/pharmacist team identified 563 drugs that were deemed problematic (15 percent). One version of the drugs-to-avoid criteria only identified 214 inappropriate drugs (6 percent). The second version had an even lower success rate, identifying only 91 drugs (2.5 percent). The two criteria versions identified 61 percent and 49 percent of drugs, respectively, as being problematic, which were not judged as being inappropriate by the expert team.

According to the researchers, while the criteria are useful, they are not accurate enough to be used as the only method to determine the quality and appropriateness of prescription drugs in the elderly.

The study was supported in part by a grant from the Agency for Healthcare Research and Quality (HS16094) to the University of Iowa CERT. For more information on the CERTs program, visit http://www.certs.hhs.gov.

See "Agreement between drugs-to-avoid criteria and expert assessments of problematic prescribing," by Michael A. Steinman, M.D., Gary E. Rosenthal, M.D., C. Seth Landefeld, M.D., and others in the July 27, 2009, Archives of Internal Medicine 169(14), pp. 1326-1332.

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Research Activities, January 2010: Patient Safety and Quality: Criteria used to identify “drugs to avoid” in the elderly are not very accurate