Diagnosed or prescribed only? A national analysis of initial evaluation and management of insomnia among older adult Medicare beneficiaries

Study Objectives To describe initial insomnia-related encounters among a national sample of Medicare beneficiaries, and to identify older adults at risk for potentially inappropriate prescription insomnia medication usage. Methods Our data source was a random 5% sample of Medicare administrative claims data (2006-2013). Insomnia was operationalized as International Classification of Disease, Ninth Revision, Clinical Modification diagnostic codes. Insomnia medications included FDA-approved insomnia-related medication classes and drugs. Logistic regression was employed to identify predictors of being “prescribed only” (i.e., being prescribed an insomnia medication without a corresponding insomnia diagnosis). Results A total of N=60,362 beneficiaries received either an insomnia diagnosis or a prescription for an insomnia medication as their first sleep-related encounter during the study period. Of these, 55.1% (n=33,245) were prescribed only, whereas 44.9% (n=27,117) received a concurrent insomnia diagnosis. In a fully adjusted regression model, younger age (odds ratio (OR) 0.98; 95% confidence interval (CI) 0.98, 0.99), male sex (OR 1.15; 95% CI 1.11, 1.20), and several comorbid conditions (i.e., dementia [OR 1.21; 95% CI 1.15, 1.27] and anemia [OR 1.17; 95% CI 1.13, 1.22]) were positively associated with being prescribed only. Conversely, black individuals (OR 0.83; 95% CI 0.78, 0.89) and those of “other” race (OR 0.89; 95% CI 0.84, 0.94) were less likely to be prescribed only. Individuals who received care from a board-certified sleep medicine provider (BCSMP) were less likely to be prescribed only (OR 0.27; 95% CI 0.16, 0.46). Conclusions Fewer than half of Medicare beneficiaries prescribed insomnia medications ever received a formal sleep-related diagnosis.

Evaluation of Potentially Inappropriate Prescription and Drug-Drug Interactions in the Critically Sick Elderly Patients in China

Background There is ongoing debate about the incidence and relationships of potentially inappropriate prescriptions and drug-drug interactions (DDIs) in elderly patients in China. Objective This study aims to evaluate the prevalence of potentially inappropriate medications (PIMs) and DDIs in elderly patients in an intensive care unit (ICU). Methods A total of 547 patients aged ≥65 years from the 30-bed ICU in a 3A (Class Three/Grade A) hospital in China over a 1-year period were included. The participant statistics and drugs prescribed were collected by the Hospital Information System (HIS). The study was limited to drugs ordered at and during ICU hospitalization. The drug list of every patient was reviewed to identify PIMs based on the 2012 Beers criteria, and the drugs implicated in PIMs were classified at five levels according to World Health Organization Anatomical Therapeutic Chemical classification. Results In total, 94.3% of the patients had prescriptions for ≥10 drugs, and 61.4% of the patients were prescribed at least one PIM. DDIs were identified in 95.6% of the medication profiles evaluated. Conclusions The results of this study conducted in an ICU setting that assessed the incidence and relationships of PIMs and pDDIs in elderly patients in China, providing baseline information and quantifying drug-related problems among critically ill elderly patients receiving PIMs. It is of clinical importance that better information must be provided to physicians and intensive care specialists regarding the risks and benefits of drug therapy, and patient compliance and inappropriate and unnecessary prescriptions must be addressed.

Addressing Barriers to Reducing Prescribing and Implementing Deprescribing of Sedative-Hypnotics in Primary Care

Objective: To describe interventions that target patient, provider, and system barriers to sedative-hypnotic (SH) deprescribing in the community and suggest strategies for healthcare teams. Data Sources: Ovid MEDLINE ALL and EMBASE Classic + EMBASE (March 10, 2021). Study Selection and Data Extraction: English-language studies in primary care settings. Data Synthesis: 20 studies were themed as patient-related and prescriber inertia, physician skills and awareness, and health system constraints. Patient education strategies reduced SH dose for 10% to 62% of participants, leading to discontinuation in 13% to 80% of participants. Policy interventions reduced targeted medication use by 10% to 50%. Relevance to Patient Care and Clinical Practice: Patient engagement and empowerment successfully convince patients to deprescribe chronic SHs. Quality improvement strategies should also consider interventions directed at prescribers, including education and training, drug utilization reviews, or computer alerts indicating a potentially inappropriate prescription by medication, age, dose, or disease. Educational interventions were effective when they facilitated patient engagement and provided information on the harms and limited evidence supporting chronic use as well as the effectiveness of alternatives. Decision support tools were less effective than prescriber education with patient engagement, although they can be readily incorporated in the workflow through prescribing software. Conclusions: Several strategies with demonstrated efficacy in reducing SH use in community practice were identified. Education regarding SH risks, how to taper, and potential alternatives are essential details to provide to clinicians, patients, and families. The strategies presented can guide community healthcare teams toward reducing the community burden of SH use.

Prescribing Patterns of Drugs in Geriatric Patient

A prospective observational study on prescribing pattern of drugs in the geriatric patients was conducted in Navodaya Medical College Hospital and Research Centre. The present study aimed to study prescribing patterns of various drugs in elderly patients and to evaluate inappropriate prescribing with the help of beers criteria. A total of 100 patients of geriatric age group(>/65 years) was included in the study for the period of 3 months of which, most of the patients were in the age group of 65-70 years (79.24%), out of which 52 were male and 48 were females. Maximum subjects were prescribed with antibiotics and proton pump inhibitors followed by analgesics. A minimum of 5 drugs were prescribed in 46 cases, followed by 5-8 drugs in 36 cases, then more than 8 drugs were prescribed in around 18 cases. Based on beers criteria 23 patients received potentially inappropriate prescription of at least 1 drug and all these belongs to category A. The study concluded that there is need for careful application of the criteria by health care professional, consumers, payers and health systems should lead to closer monitoring of drug use. Keywords: Prescribing pattern, geriatrics, beers criteria, antibiotics, analgesics.