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Research

Frequency and cost of potentially inappropriate prescribing for older adults: a cross-sectional study

Steven G. Morgan, Jordan Hunt, Jocelyn Rioux, Jeffery Proulx, Deirdre Weymann and Cara Tannenbaum
June 22, 2016 4 (2) E346-E351; DOI: https://doi.org/10.9778/cmajo.20150131
Steven G. Morgan
School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; Canadian Institute for Health Information (Hunt, Rioux, Proulx), Ottawa, Ont.; BC Cancer Agency (Weymann), Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Departments of Medicine and Pharmacy (Tannenbaum), Université de Montréal, Montréal, Que.
PhD
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Jordan Hunt
School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; Canadian Institute for Health Information (Hunt, Rioux, Proulx), Ottawa, Ont.; BC Cancer Agency (Weymann), Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Departments of Medicine and Pharmacy (Tannenbaum), Université de Montréal, Montréal, Que.
MA
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Jocelyn Rioux
School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; Canadian Institute for Health Information (Hunt, Rioux, Proulx), Ottawa, Ont.; BC Cancer Agency (Weymann), Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Departments of Medicine and Pharmacy (Tannenbaum), Université de Montréal, Montréal, Que.
BSc
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Jeffery Proulx
School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; Canadian Institute for Health Information (Hunt, Rioux, Proulx), Ottawa, Ont.; BC Cancer Agency (Weymann), Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Departments of Medicine and Pharmacy (Tannenbaum), Université de Montréal, Montréal, Que.
BSc
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Deirdre Weymann
School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; Canadian Institute for Health Information (Hunt, Rioux, Proulx), Ottawa, Ont.; BC Cancer Agency (Weymann), Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Departments of Medicine and Pharmacy (Tannenbaum), Université de Montréal, Montréal, Que.
MA
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Cara Tannenbaum
School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; Canadian Institute for Health Information (Hunt, Rioux, Proulx), Ottawa, Ont.; BC Cancer Agency (Weymann), Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Departments of Medicine and Pharmacy (Tannenbaum), Université de Montréal, Montréal, Que.
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Article Figures & Tables

Tables

    • View popup
    Table 1: Proportion of provincial drug plan enrollees aged 65 years or more who filled 1 or more potentially inappropriate prescription* in 2013, by province, sex and age group
    ProvincePopulation (%) aged ≥ 65 yr covered by NPDUIS databaseAge, yr; no. (%) of enrollees
    WomenMenOverall
    65-7475-84≥ 85All ages65-7475-84≥ 85All ages
    British Columbia769 993 (89.0)89 636 (41.5)57 288 (44.6)34 735 (50.1)181 659 (43.9)58 678 (28.8)39 299 (34.5)16 049 (41.2)114 026 (32.0)295 685 (38.4)
    Alberta411 322 (91.7)54 514 (46.5)34 388 (47.6)16 304 (47.0)105 206 (46.9)33 675 (31.5)21 163 (35.0)7 267 (37.0)62 105 (33.2)167 311 (40.7)
    Saskatchewan149 505 (93.5)14 672 (39.4)11 764 (42.8)8 762 (46.9)35 198 (42.2)9 455 (27.0)7 166 (32.5)3 246 (35.9)19 867 (30.1)55 065 (36.8)
    Manitoba171 195 (93.8)19 942 (43.3)13 606 (44.8)9 209 (46.3)42 757 (44.4)12 905 (30.8)8 353 (35.0)3 501 (38.1)24 759 (33.0)67 516 (39.4)
    Ontario1 971 856 (95.9)200 391 (36.7)152 241 (43.0)89 780 (46.1)442 412 (40.4)128 933 (26.2)96 492 (33.8)39 125 (38.9)264 550 (30.2)706 962 (35.8)
    New Brunswick73 482 (55.2)10 650 (55.3)8 238 (57.3)5 969 (61.0)24 857 (57.2)6 591 (40.6)4 689 (44.6)1 690 (50.9)12 970 (43.1)37 827 (51.5)
    Nova Scotia112 780 (67.5)15 000 (47.0)10 303 (49.0)6 559 (49.7)31 862 (48.2)10 039 (37.3)6 539 (42.8)2 013 (45.3)18 591 (39.9)50 453 (44.7)
    Prince Edward Island23 051 (91.8)2 208 (33.6)1 393 (34.6)784 (36.8)4 385 (34.5)1 324 (21.5)813 (25.0)199 (21.9)2 336 (22.6)6 721 (29.2)
    Newfoundland and Labrador49 310 (54.9)7 658 (56.0)5 787 (58.0)3 153 (60.1)16 598 (57.4)5 383 (48.5)3 762 (51.8)1 097 (53.5)10 242 (50.2)26 840 (54.4)
    All high-data-coverage provinces†3 496 922 (92.6)381 363 (39.4)270 680 (43.9)159 574 (47.0)811 617 (42.2)244 970 (27.7)173 286 (34.1)69 387 (38.9)487 643 (31.0)1 299 260 (37.2)

    Note: NPDUIS = National Prescription Drug Utilization Information System.

    *All prescriptions meeting the Beers Criteria based on drug, dosage and duration.1

    †Provinces in which at least 85% of the population aged 65 years or more is covered by the NPDUIS database: British Columbia, Alberta, Saskatchewan, Manitoba, Ontario and Prince Edward Island.

      • View popup
      Table 2: Average cost per enrollee of potentially inappropriate prescriptions, by province, sex and age
      ProvinceAge, yr; average cost, $*
      WomenMenOverall
      65-7475-84≥ 85All ages65-7475-84≥ 85All ages
      British Columbia848392856464696576
      Alberta101981011006266716484
      Saskatchewan919092916768716881
      Manitoba1039891997376747488
      Ontario6782111805566846272
      New Brunswick148142162149110109132112134
      Nova Scotia1021001011018896979197
      Prince Edward Island605860603740283749
      Newfoundland and Labrador134129138133122117126121128
      All high-data-coverage provinces7885104855966786375

      *Includes public and private shares of total ingredient costs and dispensing fees for eligible prescriptions under provincial drug benefit programs.

        • View popup
        Table 3: Proportion of enrollees who filled 1 or more potentially inappropriate prescription for the 20 most frequently used drugs on the Beers list and estimated average per-capita cost, by sex
        Drug% of enrollees who filled ≥ 1 potentially inappropriate prescriptionEstimated average per-capita cost of potentially inappropriate prescriptions, $
        WomenMenOverallWomenMenOverall
        Lorazepam11.06.18.86.953.465.40
        Nitrofurantoin8.31.95.53.230.752.13
        Amitriptyline3.92.03.14.121.853.11
        Quetiapine2.82.22.58.245.957.22
        Clonazepam3.01.92.53.021.822.49
        Zopiclone2.91.92.45.253.504.47
        Conjugated estrogens4.20.02.43.71-2.06
        Glibenclamide1.72.72.21.802.522.12
        Indomethacin0.72.61.60.301.090.65
        Terazosin0.42.91.50.825.042.70
        Oxazepam1.81.11.51.610.841.27
        Risperidone1.61.11.45.483.644.66
        Estradiol2.60.01.45.95-3.31
        Temazepam1.61.21.41.410.961.21
        Metoclopramide1.31.01.20.650.450.56
        Amiodarone0.71.10.91.412.261.79
        Meloxicam1.10.60.91.650.931.33
        Cyclobenzaprine1.00.90.90.540.400.48
        Diclofenac, combinations0.80.80.83.983.593.80
        Alprazolam1.10.60.80.960.490.75
        • View popup
        Table 4: Estimated total cost of potentially inappropriate prescriptions filled by older Canadians in 2013
        VariableWomenMenOverall
        Estimated average cost per enrollee, $84.6063.4075.00
        National population of age/sex group3 064 0002 521 0005 585 000
        Estimated total cost, $ millions259160419
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      Frequency and cost of potentially inappropriate prescribing for older adults: a cross-sectional study
      Steven G. Morgan, Jordan Hunt, Jocelyn Rioux, Jeffery Proulx, Deirdre Weymann, Cara Tannenbaum
      Jun 2016, 4 (2) E346-E351; DOI: 10.9778/cmajo.20150131

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      Frequency and cost of potentially inappropriate prescribing for older adults: a cross-sectional study
      Steven G. Morgan, Jordan Hunt, Jocelyn Rioux, Jeffery Proulx, Deirdre Weymann, Cara Tannenbaum
      Jun 2016, 4 (2) E346-E351; DOI: 10.9778/cmajo.20150131
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