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VA RESEARCH: GERIATRIC CARE LEADS TO SAFER

PRESCRIBING -- Older vets treated by a geriatric specialist were

36% less likely to receive a prescription for the wrong drug or an

incorrect dose than those who did not receive specialty care.

For more information about VA research, use the VA Watchdog search engine...click here...
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Story here... http://www.medpa
getoday.com/PrimaryCare/Geriatrics/tb/8093

Story below:

-------------------------

Geriatric Care Leads to Safer Prescribing

By Judith Groch, Senior Writer, MedPage Today

Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.

SAN ANTONIO, -- Older vets treated by a geriatric specialist were 36% less likely to receive a prescription for the wrong drug or an incorrect dose than those who did not receive specialty care, researchers here found.

And more than a quarter of men who did not receive geriatric care received prescriptions that were inappropriate or suboptimal in older patients, Mary Jo Pugh, Ph.D., R.N., of the University of Texas here, and colleagues reported in the February issue of Medical Care.

Many studies have identified patient characteristics associated with potentially inappropriate prescribing in the elderly. However, little attention has been focused on how factors such as geriatric care may affect this safety issue, the researchers wrote.

In a cross-sectional retrospective database study, the researchers used outpatient and inpatient records to identify instances of inappropriate prescribing among 850,154 men 65 or older.

Of the patients, 67% were white, 11% black, and 5% Hispanic; 98% were men. These patients had a relatively high level of disease, with 14% having eight or more comorbid physical conditions, and 23.2% having one or more psychiatric disorders.

The patients were treated at 124 geographically dispersed VA facilities from 1999 through 2000. Most facilities were teaching hospitals (80%), and 85% were located in urban areas.

Only 3% of patients (26,136) received geriatric care, and the facilities that offered it were more likely to be urban, teaching hospitals.

The proportion of patients within a facility receiving geriatric care ranged from 0 to 20%, indicating great variation in geriatric care.

Potentially inappropriate prescribing (wrong drug or dosage) was identified using the Zhan adaptation of the Beers criteria. Geriatric care was calculated as the proportion of patients within a facility who received at least one geriatric outpatient clinic or inpatient visit.

Patients receiving geriatric care in some form within the preceding year were 36% less likely to have experienced inappropriate prescribing (OR 0.64, 95% CI 0.59 to 0.73) compared with similar patients not seen by a geriatrician, the researchers reported.

However, the researchers noted that they were not able to distinguish between inpatient and outpatient geriatric care because of the low rates of geriatric care nationally.

Overall, 26.2% of older veterans who did not receive geriatric care were given drugs described as inappropriate or suboptimal for older patients, the researchers said.

Patients who did not receive geriatric care were generally younger, less likely to be black, had fewer physical or mental comorbidities, and took fewer drugs.

Moreover, there was a weak trend suggesting that patients receiving standard care in facilities with high levels of geriatric care had lower inappropriate care rates (OR 1.14, 95% CI 0.99 to 1.30) compared with facilities having fewer geriatric services.

This near-significant trend suggests that geriatric care may also affect prescribing at the facility level as a result of "trickle down" effects found when patients seen in a geriatric consultation return to their primary care provider, the researchers wrote.

Although the cross-sectional nature of this study did not permit an inference of causation, the data suggest the need for further research, the investigators said.

Study limitations included the fact that there may have been subsequent changes in practice since these data were gathered.

Also, the population of older VA patients is largely male, a group found to have more comorbidities than community-dwelling elderly men, suggesting that these findings may not be generalizable.

Finally, the investigators said, certain unmeasured characteristics, such as the use of pharmacists in primary care clinics, may be associated with lower rates of inappropriate prescribing.

In conclusion, the investigators wrote, these findings suggest that the availability of geriatric care is associated with better quality of care as measured by potentially inappropriate medication prescribing.

Because geriatric care was used by only about 3% of the study patients, it is critical that these limited resources be maximized, Dr. Pugh and her colleagues said.

They said an important question to consider is whether older patients benefit more if geriatric care is provided continuously to a small frail group, or whether a broader range of patients should receive intermittent consultation and then return to primary care.

Organization of geriatric care may be the most important factor affecting facility prescribing patterns, they concluded.

This study was funded by the Health Services Research and Development Service, Veterans Affairs, Washington.

The researchers made no declarations regarding financial conflicts of interest.

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posted by Larry Scott
Founder and Editor
VA Watchdog dot Org

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