TY - JOUR
T1 - Potentially inappropriate prescribing in elderly
T2 - Assessing doctor knowledge, confidence and barriers
AU - Ramaswamy, Ravishankar
AU - Maio, Vittorio
AU - Diamond, James J.
AU - Talati, Amy R.
AU - Hartmann, Christine W.
AU - Arenson, Christine
AU - Roehl, Barbara
PY - 2011/12
Y1 - 2011/12
N2 - Introduction: Inappropriate medication prescribing by doctors is an important preventable cause of morbidity and mortality in the elderly. This study investigates doctor knowledge about potentially inappropriate prescribing (PIP) in elderly, their confidence in prescribing for the elderly and explores perceived barriers. Methods: Family and Internal Medicine resident and attending doctors at three teaching hospitals were asked to complete a survey. Six clinical vignettes based on the 2003 Beers criteria were used to evaluate doctor knowledge about medications to avoid in the elderly. Confidence in prescribing for the elderly and perceived barriers to appropriate prescribing in elderly was assessed using a 5-point Likert scale. Results: Eighty-nine doctors completed the survey, for a response rate of 45%. Forty-four per cent of surveyed doctors estimated that over 25% of their practice consisted of patients 65 years or older. When knowledge of PIP was assessed via vignettes, the mean correct response was 3.9 (SD: 1.1, min = 1, max = 6). Only 14% of those doctors scoring ≥4 vignettes correctly had used the Beers criteria for prescribing; 31% of the doctors answering ≤5 vignettes correctly had used the Beers criteria (P = 0.08). Overall, 75% of doctors felt confident about their prescribing irrespective of their knowledge scores. Seventy per cent of surveyed doctors cited at least seven different barriers to appropriate prescribing in elderly. Conclusions: Many primary care doctors possess a poor knowledge of PIP and are unaware of prescribing guidelines such as the Beers criteria. Our survey indicates that doctor usage of the Beers criteria might correlate with improved judgement in prescribing for the elderly. Most doctors report multiple barriers to appropriate prescribing in the elderly. Lack of formal education about prescribing guidelines was the only barrier that correlated with the doctors' level of training.
AB - Introduction: Inappropriate medication prescribing by doctors is an important preventable cause of morbidity and mortality in the elderly. This study investigates doctor knowledge about potentially inappropriate prescribing (PIP) in elderly, their confidence in prescribing for the elderly and explores perceived barriers. Methods: Family and Internal Medicine resident and attending doctors at three teaching hospitals were asked to complete a survey. Six clinical vignettes based on the 2003 Beers criteria were used to evaluate doctor knowledge about medications to avoid in the elderly. Confidence in prescribing for the elderly and perceived barriers to appropriate prescribing in elderly was assessed using a 5-point Likert scale. Results: Eighty-nine doctors completed the survey, for a response rate of 45%. Forty-four per cent of surveyed doctors estimated that over 25% of their practice consisted of patients 65 years or older. When knowledge of PIP was assessed via vignettes, the mean correct response was 3.9 (SD: 1.1, min = 1, max = 6). Only 14% of those doctors scoring ≥4 vignettes correctly had used the Beers criteria for prescribing; 31% of the doctors answering ≤5 vignettes correctly had used the Beers criteria (P = 0.08). Overall, 75% of doctors felt confident about their prescribing irrespective of their knowledge scores. Seventy per cent of surveyed doctors cited at least seven different barriers to appropriate prescribing in elderly. Conclusions: Many primary care doctors possess a poor knowledge of PIP and are unaware of prescribing guidelines such as the Beers criteria. Our survey indicates that doctor usage of the Beers criteria might correlate with improved judgement in prescribing for the elderly. Most doctors report multiple barriers to appropriate prescribing in the elderly. Lack of formal education about prescribing guidelines was the only barrier that correlated with the doctors' level of training.
KW - Beers criteria
KW - adverse drug events
KW - barriers
KW - doctor knowledge
KW - elderly
KW - potentially inappropriate prescribing
UR - http://www.scopus.com/inward/record.url?scp=80755143979&partnerID=8YFLogxK
U2 - 10.1111/j.1365-2753.2010.01494.x
DO - 10.1111/j.1365-2753.2010.01494.x
M3 - Article
C2 - 20630004
AN - SCOPUS:80755143979
SN - 1356-1294
VL - 17
SP - 1153
EP - 1159
JO - Journal of Evaluation in Clinical Practice
JF - Journal of Evaluation in Clinical Practice
IS - 6
ER -