Agreement between drugs-to-avoid criteria and expert assessments of problematic prescribing

Michael A Steinman; Gary E Rosenthal; C Seth Landefeld; Daniel Bertenthal; Peter J Kaboli

doi:10.1001/archinternmed.2009.206

Back

Agreement between drugs-to-avoid criteria and expert assessments of problematic prescribing

Journal article

Open access

Peer reviewed

Agreement between drugs-to-avoid criteria and expert assessments of problematic prescribing

Michael A Steinman, Gary E Rosenthal, C Seth Landefeld, Daniel Bertenthal and Peter J Kaboli

Archives of internal medicine (1960), Vol.169(14), pp.1326-1332

07/27/2009

DOI: 10.1001/archinternmed.2009.206

PMCID: PMC2758269

PMID: 19636035

Files and links (1)

url

https://doi.org/10.1001/archinternmed.2009.206View

Published (Version of record) Open Access

Abstract

Drugs-to-avoid criteria are commonly used to evaluate prescribing quality in elderly persons. However, few studies have evaluated the concordance between these criteria and individualized patient assessments as measures of problem prescribing. We used data on 256 outpatients from the Iowa City VA Medical Center who were 65 years or older and taking 5 or more medications. After a comprehensive patient interview, a study team composed of a physician and a pharmacist recommended that certain drugs be discontinued, substituted, or reduced in dose. We evaluated the degree to which drugs considered potentially inappropriate by the drugs-to-avoid criteria of Beers et al and Zhan et al (hereinafter, Beers criteria and Zhan criteria) were also considered problematic by the study team, and vice versa. In the study cohort, 256 patients were using 3678 medications. The physician-pharmacist team identified 563 drugs (15%) as problematic, while 214 drugs (6%) were flagged as potentially inappropriate by the Beers criteria and 91 drugs (2.5%) were flagged as potentially inappropriate using the Zhan criteria. The kappa statistics for concordance between drugs-to-avoid criteria and expert assessments were 0.10 to 0.14, indicating slight agreement between these measures. Sixty-one percent of drugs identified as potentially inappropriate by the Beers criteria and 49% of drugs flagged by the Zhan criteria were not judged to be problematic by the expert reviewers. Correspondence between drugs-to-avoid criteria and expert assessment varied widely across different types of drugs. Drugs-to-avoid criteria have limited power to differentiate between drugs and patients with and without prescribing problems identified on individualized expert review. Although these criteria are useful as guides for initial prescribing decisions, they are insufficiently accurate to use as stand-alone measures of prescribing quality.

Medication Errors

Prescription Drugs

Risk Assessment

Humans

Nonprescription Drugs

Female

Male

Medication Therapy Management

Aged

Drug Utilization Review - standards

Contraindications

Details

Title: Subtitle: Agreement between drugs-to-avoid criteria and expert assessments of problematic prescribing
Creators: Michael A Steinman - San Francisco VA Medical Center, San Francisco, CA 94121, USA. mike.steinman@ucsf.edu
Gary E Rosenthal
C Seth Landefeld
Daniel Bertenthal
Peter J Kaboli
Resource Type: Journal article
Publication Details: Archives of internal medicine (1960), Vol.169(14), pp.1326-1332
DOI: 10.1001/archinternmed.2009.206
PMID: 19636035
PMCID: PMC2758269
NLM abbreviation: Arch Intern Med
ISSN: 0003-9926
eISSN: 1538-3679
Publisher: American Medical Association
Grant note: 1K23AG030999 / NIA NIH HHS K23 AG030999-01A1 / NIA NIH HHS K07 AG000912 / NIA NIH HHS U18 HS016094 / AHRQ HHS 5 U18 HSO16094 / PHS HHS AG 10418 / NIA NIH HHS AG 00912 / NIA NIH HHS K23 AG030999 / NIA NIH HHS Z01 AG000912 / Intramural NIH HHS
Language: English
Date published: 07/27/2009
Academic Unit: Epidemiology; Internal Medicine
Record Identifier: 9984094377902771

Metrics

18 Record Views

50 Times Cited - Web of Science