- What is the current prevalence of polypharmacy in BC in the elderly?
- What classes of medications are commonly prescribed in BC?
- What are the rates of prescribing of inappropriate medication prescriptions in the elderly?
Inappropriate prescribing in the elderly is a quality and safety issue [REF]. Polypharmacy is one example of potential inappropriate prescribing as medications are more likely to have side effects and are often less effective in the elderly.
Polypharmacy is the multiple drugs, more than are strictly necessary and therefore increase potential harm (e.g. Through drug interactions) over potential good. It is significant in all age groups, but especially in elderly who have more side effects, less over benefit from chronic medications, and are often on multiple medications for multiple health conditions.
This study will work with the BC Network of Researchers to assess prescribing patterns in the elderly population, as determined by medication lists in the EMRs. Engaged practices will allow for analysis on current prescribing practices. The researchers will assess rates of overall prescribing as well as specific details of what is prescribed to patients over 70 years of age.
Findings from this quick observational study will then be used to trigger: smaller QI activities as well as interventional studies. Knowledge Translation will include presentations to the network.
What is the current prevalence of polypharmacy in BC in the elderly?
In order to know the prevalence of something, you need the numerator and denominator. Therefore this question needs to be broken down into:
A = What is the current number of patients >70 years old in the network?
B = What is the current number of patients >70 years old that are on more than 5 medications?
Simply, Rate = B / A
What classes medications are commonly prescribed in BC?
Medications can be classified in several different ways. This is helpful when looking at populations of patients. ATC (Anatomic Therapeutic Chemical) is one classification scheme that is useful and readily available. There is also a freely available DIN (Drug Identification Number) –> ATC mapping in the Health Canada Drug Product Database. OSCAR and several BC EMRs use DINs in their prescribing module.
Therefore, this question will produce a graph of the top 10 commonly prescribed classes of medications. The Question Manager, as we develop the question will work with the researcher to determine which level of ATC classes are most meaningful. This will highlight the ability for SCOOP to be iterative.
What are the rates of prescribing of inappropriate medications in the elderly?
There are several consensus and evidence-based recommendations for safer prescribing in the elderly.
Initially, for our work, we will use a sub-set of the recently updated 2012 Beers’ Criteria to report against. The rationale for using the Beers’ criteria initially is that the newer version references evidence and many of the recommendations are only based on age.
STOPP/START criteria is another option and one that we will explore later in SCOOP development. We will use STOPP/START criteria later and compare findings with Beers. The rationale here is that many of these criteria require additional information (Drug-drug interactions, drug-disease) and these will be available in SCOOP as we develop over time.
Expected Minimum Data Requirements from the EMR to the Endpoint:
- Practice ID
- Patient Age
- Current Medication List Details
(this will be expanded as we expand the scope of these questions (e.g. add in START/STOPP)