High risk prescribing in primary care patients particularly vulnerable to adverse drug events: cross sectional population database analysis in Scottish general practice

@article{Guthrie2011HighRP,
  title={High risk prescribing in primary care patients particularly vulnerable to adverse drug events: cross sectional population database analysis in Scottish general practice},
  author={Bruce Guthrie and Colin McCowan and Peter G. Davey and Colin Simpson and Tobias Dreischulte and Karen N Barnett},
  journal={BMJ : British Medical Journal},
  year={2011},
  volume={342}
}
Objective To examine the prevalence and patterns of high risk prescribing, defined as potentially inappropriate prescribing of drugs to primary care patients particularly vulnerable to adverse drug events. Design Cross sectional population database analysis. Setting General practices in Scotland. Participants 315 Scottish general practices with 1.76 million registered patients, 139 404 (7.9%) of whom were defined as particularly vulnerable to adverse drug events because of age, comorbidity, or… 
Examining variations in prescribing safety in UK general practice: cross sectional study using the Clinical Practice Research Datalink
TLDR
The high prevalence for certain indicators emphasises existing prescribing risks and the need for their appropriate consideration within primary care, particularly for older patients and those taking multiple medications.
Potentially inappropriate primary care prescribing in people with chronic kidney disease: a cross-sectional analysis of a large population cohort
  • C. MacRae, S. Mercer, B. Guthrie
  • Medicine, Political Science
    The British journal of general practice : the journal of the Royal College of General Practitioners
  • 2020
TLDR
Developing and evaluation of interventions to improve prescribing safety in this high-risk population of people with known CKD are needed.
Evaluating the safety of mental health-related prescribing in UK primary care: a cross-sectional study using the Clinical Practice Research Datalink (CPRD)
TLDR
Potentially hazardous prescribing and inadequate medication monitoring commonly affect patients with mental illness in primary care, with marked between-practice variation for some indicators.
High-risk prescribing and monitoring in primary care: how common is it, and how can it be improved?
TLDR
A systematic approach to improve the safety of medication use in primary care is proposed, based on previously developed interventions to change professional practice, and areas for future research are highlighted.
Primary Care Medication Safety Surveillance with Integrated Primary and Secondary Care Electronic Health Records: A Cross-Sectional Study
TLDR
Systematic collection, collation, and analysis of linked primary and secondary care records produce plausible and useful information about medication safety for a health system, and should pay close attention to patient age and polypharmacy with respect to both prescribing and monitoring failures.
Impact of Potentially Inappropriate Prescribing on Adverse Drug Events, Health Related Quality of Life and Emergency Hospital Attendance in Older People Attending General Practice: A Prospective Cohort Study
TLDR
Older community-dwelling people, prescribed ≥2 STOPP PIP are more likely to report ADEs, poorer health related quality of life and attend the accident & emergency department over 2-year follow-up.
Potentially inappropriate prescribing and adverse health outcomes in community dwelling older patients.
TLDR
Reducing PIP in primary care may help lower the burden of ADEs, its associated health care use and costs and enhance quality of life in older patients.
Are primary care factors associated with hospital episodes for adverse drug reactions? A national observational study
TLDR
Various aspects of primary care are associated with ADR-related hospital episodes, including achievement of particular QOF indicators, and interventions in primary care could help reduce the ADR burden.
Bad apples or spoiled barrels? Multilevel modelling analysis of variation in high-risk prescribing in Scotland between general practitioners and between the practices they work in
TLDR
There was much more variation in high- risk prescribing between GPs than between practices, and only targeting practices with higher than average rates will miss most high-risk NSAID prescribing.
Assessing potentially inappropriate prescribing (PIP) and predicting patient outcomes in Ontario’s older population: a population-based cohort study applying subsets of the STOPP/START and Beers’ criteria in large health administrative databases
TLDR
The occurrence of PIP in Ontario's older population (aged 65 years and older) is described and the health outcomes and health system costs associated with PIP are assessed to assess the association between PIP and the occurrence of ED visits, hospitalisations and death, and their related costs.
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 42 REFERENCES
The Quality of Pharmacologic Care for Vulnerable Older Patients
TLDR
This study systematically evaluated medication management for a sample of older patients by taking advantage of a set of explicit process of care quality indicators developed and implemented in the Assessing Care of Vulnerable Elders (ACOVE) project.
Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients
TLDR
The burden ofADRs on the NHS is high, accounting for considerable morbidity, mortality, and extra costs, and measures need to be put into place to reduce the burden of ADRs and thereby further improve the benefit:harm ratio of the drugs.
Increased mortality and cardiovascular morbidity associated with use of nonsteroidal anti-inflammatory drugs in chronic heart failure.
TLDR
NSAIDs are frequently used in patients with HF and are associated with increased risk of death and cardiovascular morbidity, inasmuch as even commonly used NSAIDs exerted increased risk.
STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers' criteria.
TLDR
STOPP criteria identified a significantly higher proportion of patients requiring hospitalisation as a result of PIM-related adverse events than Beers' criteria, which has significant implications for hospital geriatric practice.
Drug–drug interactions between antithrombotic medications and the risk of gastrointestinal bleeding
TLDR
Drug combinations involving antiplatelets and anticoagulants are associated with a high risk of gastrointestinal bleeding beyond that associated with each drug used alone, and Physicians should be aware of these risks to better assess their patients' therapeutic risk–benefit profiles.
Nonsteroidal anti-inflammatory drugs and risk of ARF in the general population.
TLDR
NSAID users had a 3-fold greater risk for developing a first-ever diagnosis of clinical ARF compared with non-NSAIDs users in the general population, and NSAIDs should be used with special caution in patients with hypertension and/or HF.
The unreliability of individual physician "report cards" for assessing the costs and quality of care of a chronic disease.
TLDR
Use of individual physician profiles may foster an environment in which physicians can most easily avoid being penalized by avoiding or deselecting patients with high prior cost, poor adherence, or response to treatments.
Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts.
TLDR
The application of the Beers criteria and other tools for identifying potentially inappropriate medication use will continue to enable providers to plan interventions for decreasing both drug-related costs and overall costs and thus minimize drug- related problems.
Which drugs cause preventable admissions to hospital? A systematic review.
TLDR
Four groups of drugs account for more than 50% of the drug groups associated with preventable drug-related hospital admissions, and concentrating interventions on these drug groups could reduce appreciably the number of preventable drugs-related admissions to hospital from primary care.
STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation.
TLDR
STOP/START is a valid, reliable and comprehensive screening tool that enables the prescribing physician to appraise an older patient's prescription drugs in the context of his/her concurrent diagnoses.
...
1
2
3
4
5
...