Prevalence of inappropriate prescribing in complex chronic patients: Time trends in a health department of Valencia, Spain (2015-2019).

BACKGROUND AND OBJECTIVE: Inappropriate prescribing (IP) is an important cause of health problems among elderly and complex chronic patients (CCPs). OBJECTIVE: Surveillance of IP prevalence among elderly and CCPs in a health department. IP time trends across the period 2015-2019. METHOD: Descriptive population-based study. SETTING: 'València-Clínic-Malvarrosa' Health Department, Valencia, Spain. PERIOD: 2015-2019. SUBJECTS: Complete set of CCPs in the department, defined by clinical risk groups. Number of CCPs (annual average in the period): 9102 (75% ≥65 years of age). IP was measured using an indicator consisting of 13 specific types of prescriptions defined as inappropriate. ANALYSES: frequencies and time trends, both overall and by specific type. RESULTS: Overall prevalence of IP ranged from 0.276 (2015) to 0.289 (2018) per patient, without time trend. The most frequent inappropriate prescription was type 1: "≥75 years of age with inappropriate medication", which showed a stable rate across the period. Some types of inappropriate prescriptions displayed favourable decreasing time trends, while others showed no change or an unfavourable trend (i.e., joint prescription of absorbents and urinary antispasmodics). CONCLUSIONS: IP prevalence is a serious and persistent problem among the elderly and CCPs, especially in the oldest. It is therefore necessary its continuous surveillance (overall and by specific types of prescription). As well as interventions to optimise prescribing, thus improving the quality and efficiency of care for the elderly and CCPs.

Prevalence of inappropriate prescribing in complex chronic patients: Time trends in a health department of Valencia, Spain (2015–2019) / Prevalencia de prescripción inapropiada en pacientes crónicos complejos: tendencias temporales en un departamento de salud de Valencia, España (2015-2019)

Background and objective: Inappropriate prescribing (IP) is an important cause of health problems among elderly and complex chronic patients (CCPs).Objective: Surveillance of IP prevalence among elderly and CCPs in a health department. IP time trends across the period 2015–2019.Method: Descriptive population-based study. Setting: ‘València-Clínic-Malvarrosa’ Health Department, Valencia, Spain. Period: 2015–2019. Subjects: Complete set of CCPs in the department, defined by clinical risk groups. Number of CCPs (annual average in the period): 9102 (75% ≥65 years of age). IP was measured using an indicator consisting of 13 specific types of prescriptions defined as inappropriate. Analyses: frequencies and time trends, both overall and by specific type.Results: Overall prevalence of IP ranged from 0.276 (2015) to 0.289 (2018) per patient, without time trend. The most frequent inappropriate prescription was type 1: “≥75 years of age with inappropriate medication”, which showed a stable rate across the period. Some types of inappropriate prescriptions displayed favourable decreasing time trends, while others showed no change or an unfavourable trend (i.e., joint prescription of absorbents and urinary antispasmodics).Conclusions: IP prevalence is a serious and persistent problem among the elderly and CCPs, especially in the oldest. It is therefore necessary its continuous surveillance (overall and by specific types of prescription). As well as interventions to optimise prescribing, thus improving the quality and efficiency of care for the elderly and CCPs. (AU)

Antecedentes y objetivo: La prescripción inapropiada (PI) es una importante causa de problemas de salud en las personas mayores y pacientes crónicos complejos (PCC). Objetivo: Monitorizar la prevalencia de PI en personas mayores y PCC, en un departamento de salud. Tendencias temporales de la PI durante 2015-2019.Método: Estudio descriptivo de base poblacional. Lugar: Departamento de Salud «València-Clínic-Malvarrosa», Valencia, España. Periodo: 2015-2019. Sujetos: Conjunto completo de PCC en el Departamento, definidos mediante Clinical Risk Groups. Número de PCC (valor promedio anual en el periodo): 9.102 (75% ≥65 años de edad). La PI se cuantificó mediante un indicador que comprende 13 tipos concretos de prescripciones definidas como inapropiadas. Análisis: frecuencias y tendencia temporal, global y por tipos.Resultados: La prevalencia global de PI osciló entre 0,276 (2015) y 0,289 (2018) por paciente, sin tendencia temporal. El tipo concreto de PI más frecuente fue el 1: «≥75 años con medicación inapropiada», y fue estable en el periodo. Algunos de los tipos inapropiados de prescripción mostraron evolución temporal favorable, descendente; pero en otros no hubo cambios o fue desfavorable (como la prescripción conjunta de absorbentes y antiespasmódicos urinarios).Conclusiones: La prevalencia de la PI constituye un problema importante y persistente en las personas mayores y PCC, especialmente en las de más edad. Es pues necesaria su monitorización continuada (global y por tipos de prescripción), así como intervenciones para optimizar la prescripción, mejorando la calidad y eficiencia de la asistencia a las personas mayores y PCC. (AU)