چکیده (انگلیسی):

Background:Based on changes in pharmacokinetics and–dynamics in elderly patients, there are potentially
inappropriate medications (PIM) that should be avoided in patients aged≥65 years. Current studies showed
prescription rates of PIM between 22.5 and 28.4 % inthe primary care setting. The evidence concerning
reasons for PIM prescription by FPs is limited.
Methods:This mixed method study consisted of three research parts: 1) semi-standardized content analysis of patients’
records, 2) qualitative interviews with FPs using a) open questions and b) selected patient-specific case vignettes and 3)
qualitative interviews with FPs’ medical assistants. The integration of qualitative interviews was used to explain the
quantitative results (triangulation design). PIM were identified according to the German PRISCUS list. Descriptive and
multivariate statistical analysis was done using SPSS 22.0. Qualitative content analysis of interviews was used to classify the
content of the interviews for indicating pertinent categories. All data were pseudonymously recorded and analyzed.
Results:Content analysis of 1846 patients’ records and interviews with 7 related FPs were conducted. Elderly
patients [n= 1241, mean age: 76, females: 56.6 %] were characterized in average by 8.3 documented chronic
diagnosis. 23.9 % of elderly patients received at least one PIM prescription. Sedatives/hypnotics were the most
frequent prescribed PIM-drugs (13.7 %). Mental disorders, gender and number of long-term medication were
detected as predictors for the probability of a PIM prescription. Common reported reasons for PIM prescription by FPs
concerned limited knowledge regarding PIM, limited applicability of PIM lists in daily practice, lack of time, having no
alternatives in medication, stronger patient-related factors than age that influence prescription, own bad experiences
regarding changes of medication or refusal of following prescriptions of sedative/hypnotics.
Conclusions:It is essential to see FPs in a complex decision making situation with several influencing factors on their
prescribing, including: patient-oriented prioritization, FPs’ experiences in daily practice, FPs’ knowledge regarding
existing recommendations and their trust in it and organizational characteristics of FPs’ daily medical practice. These
pros and cons of PIM prescription in elderly patients should be considered in FPs’ advanced training.