sábado, 24 de noviembre de 2012

Facility-level variation in potentially ina... [J Am Geriatr Soc. 2012] - PubMed - NCBI

J Am Geriatr Soc. 2012 Jul;60(7):1222-9. doi: 10.1111/j.1532-5415.2012.04042.x. Epub 2012 Jun 21.

Facility-level variation in potentially inappropriate prescribing for older veterans.

Gellad WF, Good CB, Amuan ME, Marcum ZA, Hanlon JT, Pugh MJ.

Source

Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania 15206, USA. walid.gellad@va.gov

Abstract

OBJECTIVES:

To describe facility-level variation in two measures of potentially inappropriate prescribing prevalent in Veterans Affairs (VA) facilities-exposure to high-risk medications in elderly adults (HRME) and drug-disease interactions (Rx-DIS)-and to identify facility characteristics associated with high-quality prescribing.

DESIGN:

Cross-sectional.

SETTING:

VA Healthcare System.

PARTICIPANTS:

Veterans aged 65 and older with at least one inpatient or outpatient visit in 2005-2006 (N = 2,023,477; HRME exposure) and a subsample with a history of falls or hip fractures, dementia, or chronic renal failure (n = 305,059; Rx-DIS exposure).

MEASUREMENTS:

Incident use of any HRME (iHRME) and incident Rx-DIS (iRx-DIS) and facility-level rates and facility-level predictors of iHRME and iRx-DIS exposure, adjusting for differences in patient characteristics.

RESULTS:

Overall, 94,692 (4.7%) veterans had iHRME exposure. At the facility level, iHRME exposure ranged from 1.6% at the lowest facility to 12.8% at the highest (median 4.7%). In the subsample, 9,803 (3.2%) veterans had iRx-DIS exposure, with a facility-level range from 1.3% to 5.8% (median 3.2%). In adjusted analyses, veterans seen in facilities with formal geriatric education had lower odds of iHRME (odds ratio (OR) = 0.86, 95% confidence interval (CI) = 0.77-0.96) and iRx-DIS (OR = 0.95, 95% CI = 0.88-1.01). Patients seen in facilities caring for fewer older veterans had greater odds of iHRME (OR = 1.54, 95% CI = 1.35-1.75) and iRx-DIS exposure (OR = 1.22, 95% CI = 1.11-1.33).

CONCLUSION:

Substantial variation in the quality of prescribing for older adults exists across VA facilities, even after adjusting for patient characteristics. Higher-quality prescribing is found in facilities caring for a larger number of older veterans and facilities with formal geriatric education.
© 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.