Beers et al. studied prescribing appropriateness in a prospective cohort study of 1106 residents of 12 nursing homes in the greater Los Angeles area. Prescribing appropriateness was evaluated using explicit criteria developed by 13 experts from the United States and Canada. The experts reached consensus about 19 drugs that should generally be avoided in the elderly and 11 doses, frequencies, or durations of use of specific drugs that generally should not be exceeded. Based on these criteria, 7% of all prescriptions were inappropriate: 40% of residents received at least one inappropriate medication order, while 10% received two or more concurrent inappropriate medication orders.46
Buetow et al. investigated the prevalence of potentially inappropriate long-term prescribing in general practice in the United Kingdom. Explicit criteria were developed through the review of 62 published studies of prescribing appropriateness. The proposed criteria were submitted to a panel of ten experts. The nominal group method was used to derive detailed criteria. The panel reached consensus for 19 indicators of inappropriate long-term prescribing representing five dimensions: indication, choice of drug, drug administration, communication, and review.47
Prevalence of potentially inappropriate prescribing varied by indicator and chronic condition. The lowest prevalence was found for inappropriate therapeutic drug choice (excluding drug cost). The highest was for inappropriate dosages. The authors concluded that the evidence of widespread inappropriate prescribing in general practice is unsound. Although inappropriate prescribing occurs, the magnitude of the problem could not be determined because of limitations in the literature associated with selection of a standard publication bias and uncertainty about the context of prescribing decisions. The authors concluded that indicators applicable to individual patients could yield evidence of prescribing appropriateness.
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