Using explicit criteria to evaluate the quality of prescribing in elderly Italian outpatients: a cohort study

P>Background and objective: Inappropriate prescribing in the elderly population is a well-recognized problem in public health. The Beers criteria have been widely used to evaluate the quality of prescribing for the elderly. However, because the Beers criteria were developed in the United States, they are not fully applicable in Italy. The purpose of this study was to establish explicit criteria for potentially inappropriate medication prescribing (PIP) for the elderly and assess the prevalence of and factors associated with PIP among elderly residents in the Local Health Unit of Parma, Italy according to the developed criteria. Methods: A nine-member expert panel was convened to identify a list of inappropriate medications reflecting the Italian prescribing habits. The panel decided to refine and update the 2002 Beers criteria. Consensus through a Nominal Group Technique was reached to classify the identified 23 inappropriate medications into three categories: 17 medications to be always avoided, three medications rarely appropriate, and three medications with some indications but often misused. A retrospective cohort study using the 2006 Parma Local Health Unit automated outpatient prescriptions database was conducted. The cohort comprised 91 741 elderly individuals >= 65 years with at least one prescription medication. PIP was defined as having a prescription claim for at least one inappropriate medication. Results and discussion: A total of 23 662 elderly in the cohort (25 center dot 8%) had at least one PIP. Of these, 14 center dot 1% received prescriptions for two medications of concern, and 2 center dot 0% for three or more. Using the expert panel's categories, 59 center dot 2% of the elderly receiving PIP had prescriptions for drugs that should always be avoided, 33 center dot 9% for rarely appropriate drugs, and 19 center dot 1% for drugs that have some indications but are often misused. Non-steroidal anti-inflammatory drugs (35 center dot 7% of subjects) were the most frequently occurring PIP, followed by ticlopidine (17 center dot 6%), doxazosin (15 center dot 5%), and amiodarone (13 center dot 6%). Female, older age, overall number of drugs prescribed, greater number of chronic conditions were factors associated with greater odds of receiving PIP. Conclusion: Via the developed criteria, the study corroborates that PIP among elderly outpatients is a substantial issue in Parma Local Health Unit, Italy. Knowledge of the prevalence of PIP and associated factors should gear efforts to develop strategies to reduce PIP in outpatient settings in Italy.