Journal
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
Volume 63, Issue 4, Pages 699-707Publisher
WILEY
DOI: 10.1111/jgs.13318
Keywords
acute myocardial infarction; Healthcare Effectiveness Data and Information Set measures; Medicare; potentially inappropriate prescribing; quality of care
Categories
Funding
- Agency for Healthcare Research and Quality [1 R01 HSO18381-01A1]
- Health Services Research and Development Service, Department of Veterans Affairs [10-017]
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ObjectivesTo determine whether acute hospitalization is associated with a change in potentially inappropriate medication (PIM) use and whether use varies across geographic region. DesignObservational. SettingContinental United States. ParticipantsMedicare beneficiaries aged 65 and older hospitalized for acute myocardial infarction (AMI) during 2007-08. MeasurementsPotentially inappropriate medication use was defined according to the High-Risk Medications in Elderly Adults quality indicator from the Healthcare Effectiveness Data and Information Set. Prevalence of outpatient PIM use was determined at admission and discharge and then used to identify medications discontinued during hospitalization and incident medications started during this period. ResultsOf 124,051 older adults hospitalized for AMI, 9,607 (7.7%) were outpatient PIM users at admission, which increased to 8.6% at discharge (P<.001). Admission PIM rates varied according to geographic region, as did the effect of hospitalization. Admission PIM use was lowest in the northeast and remained unchanged during hospitalization (5.1-5.1%, P=.95). In contrast, admission PIM use was highest in the south and increased significantly during hospitalization (9.9-11.4%, P<.001). PIM use also increased from the long-term perspective, with 6-month period prevalence rates of 22.6% before admission and 24.6% after discharge (P<.001). ConclusionDespite intervention studies demonstrating up to 80% reduction in PIM use during acute hospitalization, a significant increase in PIM use was observed in a naturalistic setting in Medicare beneficiaries with AMI. Further research is needed to develop an approach to minimizing PIM use in the inpatient setting that is cost-effective and suitable for widespread implementation.
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