Assessing potentially inappropriate prescribing (PIP) and predicting patient outcomes in Ontario's older population: a population-based cohort study applying subsets of the STOPP/START and Beers' criteria in large health administrative databases

Lise M Bjerre, Timothy Ramsay, Catriona Cahir, Cristín Ryan, Roland Halil, Barbara Farrell, Kednapa Thavorn, Christina Catley, Steven Hawken, Ulrika Gillespie, Douglas G Manuel, Lise M Bjerre, Timothy Ramsay, Catriona Cahir, Cristín Ryan, Roland Halil, Barbara Farrell, Kednapa Thavorn, Christina Catley, Steven Hawken, Ulrika Gillespie, Douglas G Manuel

Abstract

Introduction: Adverse drug events (ADEs) are common in older people and contribute significantly to emergency department (ED) visits, unplanned hospitalisations, healthcare costs, morbidity and mortality. Many ADEs are avoidable if attention is directed towards identifying and preventing inappropriate drug use and undesirable drug combinations. Tools exist to identify potentially inappropriate prescribing (PIP) in clinical settings, but they are underused. Applying PIP assessment tools to population-wide health administrative data could provide an opportunity to assess the impact of PIP on individual patients as well as on the healthcare system. This would open new possibilities for interventions to monitor and optimise medication management on a broader, population-level scale.

Methods and analysis: The aim of this study is to describe the occurrence of PIP in Ontario's older population (aged 65 years and older), and to assess the health outcomes and health system costs associated with PIP-more specifically, the association between PIP and the occurrence of ED visits, hospitalisations and death, and their related costs. This will be done within the framework of a population-based retrospective cohort study using Ontario's large health administrative and population databases. Eligible patients aged 66 years and older who were issued at least 1 prescription between 1 April 2003 and 31 March 2014 (approximately 2 million patients) will be included.

Ethics and dissemination: Ethical approval was obtained from the Ottawa Health Services Network Ethical Review Board and from the Bruyère Research Institute Ethics Review Board. Dissemination will occur via publication, presentation at national and international conferences, and ongoing exchanges with regional, provincial and national stakeholders, including the Ontario Drug Policy Research Network and the Ontario Ministry of Health and Long-Term Care.

Trial registration number: Registered with clinicaltrials.gov (registration number: NCT02555891).

Keywords: EPIDEMIOLOGY; GERIATRIC MEDICINE.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Figures

Figure 1
Figure 1
Definition of observation period (OHIP, Ontario Health Insurance Plan).
Figure 2
Figure 2
Description of study cohort creation (PIP, potentially inappropriate prescribing).
Figure 3
Figure 3
Time-to-event as a function of potentially inappropriate prescribing (PIP): possible patient scenarios, definition of eligible exposure and of outcome observation time window.

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