2 research outputs found
Trends and interaction of polypharmacy and potentially inappropriate prescribing in primary care over 15 years in Ireland: a repeated cross-sectional study.
OBJECTIVES: To examine: (1) changes in polypharmacy in 1997, 2002, 2007 and 2012 and; (2) changes in potentially inappropriate prescribing (PIP) prevalence and the relationship between PIP and polypharmacy in individuals aged ≥65 years over this period in Ireland.
METHODS: This repeated cross-sectional study using pharmacy claims data included all individuals eligible for the General Medical Services scheme in the former Eastern Health Board region of Ireland in 1997, 2002, 2007 and 2012 (range 338 025-539 752 individuals). Outcomes evaluated were prevalence of polypharmacy (being prescribed ≥5 regular medicines) and excessive polypharmacy (≥10 regular medicines) in all individuals and PIP prevalence in those aged ≥65 years determined by 30 criteria from the Screening Tool for Older Persons' Prescriptions.
RESULTS: The prevalence of polypharmacy increased from 1997 to 2012, particularly among older individuals (from 17.8% to 60.4% in those aged ≥65 years). The adjusted incident rate ratio for polypharmacy in 2012 compared to 1997 was 4.16 (95% CI 3.23 to 5.36), and for excessive polypharmacy it was 10.53 (8.58 to 12.91). Prevalence of PIP rose from 32.6% in 1997 to 37.3% in 2012. High-dose aspirin and digoxin prescribing decreased over time, but long-term proton pump inhibitors at maximal dose increased substantially (from 0.8% to 23.8%). The odds of having any PIP in 2012 were lower compared to 1997 after controlling for gender and level of polypharmacy, OR 0.39 (95% CI 0.39 to 0.4).
CONCLUSIONS: Accounting for the marked increase in polypharmacy, prescribing quality appears to have improved with a reduction in the odds of having PIP from 1997 to 2012. With growing numbers of people taking multiple regular medicines, strategies to address the related challenges of polypharmacy and PIP are needed.</p
Quantifying patient preferences for symptomatic breast clinic referral: a decision analysis study
Objectives Decision analysis study that incorporates
patient preferences and probability estimates to
investigate the impact of women’s preferences for referral
or an alternative strategy of watchful waiting if faced with
symptoms that could be due to breast cancer.
Setting Community-based study.
Participants Asymptomatic women aged 30–60 years.
Interventions Participants were presented with 11 health
scenarios that represent the possible consequences
of symptomatic breast problems. Participants were
asked the risk of death that they were willing to take in
order to avoid the health scenario using the standard
gamble utility method. This process was repeated for
all 11 health scenarios. Formal decision analysis for the
preferred individual decision was then estimated for each
participant.
Primary outcome measure The preferred diagnostic
strategy was either watchful waiting or referral to a breast
clinic. Sensitivity analysis was used to examine how each
varied according to changes in the probabilities of the
health scenarios.
Results A total of 35 participants completed the
interviews, with a median age 41 years (IQR 35–47 years).
The majority of the study sample was employed (n=32,
91.4%), with a third-level (university) education (n=32,
91.4%) and with knowledge of someone with breast
cancer (n=30, 85.7%). When individual preferences were
accounted for, 25 (71.4%) patients preferred watchful
waiting to referral for triple assessment as their preferred
initial diagnostic strategy. Sensitivity analysis shows that
referral for triple assessment becomes the dominant
strategy at the upper probability estimate (18%) of breast
cancer in the community.
Conclusions Watchful waiting is an acceptable strategy
for most women who present to their general practitioner
(GP) with breast symptoms. These findings suggest that
current referral guidelines should take more explicit
account of women’s preferences in relation to their GPs
initial management strategy