چکیده (انگلیسی):

Background:Health care policy-makers look for prescribing indicators at the population level to evaluate the
performance of prescribers, improve quality and control drug costs. The aim of this research was to; (i) estimate
the level of variation in potentially inappropriate prescribing (PIP) across prescribers in the national Irish older
population using the STOPP criteria; (ii) estimate how reliably the criteria could distinguish between prescribers
in terms of their proportion of PIP and; (iii) examine how PIP varies between prescribers and by patient and
prescriber characteristics in a multilevel regression model.
Methods:1,938 general practitioners (GPs) with 338,375 registered patients’ ≥70 years were extracted from the
Health Service Executive Primary Care Reimbursement Service (HSE-PCRS) pharmacy claims database. HSE-PCRS
prescriptions are WHO ATC coded. Demographic data for claimants’ and prescribers’ are available. Thirty STOPP
indicators were applied to prescription claims in 2007. Multilevel logistic regression examined how PIP varied
between prescribers and by individual patient and prescriber level variables.
Results:The unadjusted variation in PIP between prescribers was considerable (median 35%, IQR 30-40%). The
STOPP criteria were reliable measures of PIP (average >0.8 reliability). The multilevel regression models found that
only the patient level variable, number of different repeat drug classes was strongly associated with PIP (>2 drugsv
none; adjusted OR, 4.0; 95% CI 3.7, 4.3). After adjustment for patient level variables the proportion of PIP varied fourfold
(0.5 to 2 times the expected proportion) between prescribers but the majority of this variation was not significant.
Conclusion:PIP is of concern for all prescribers. Interventions aimed at enhancing appropriateness of prescribing
should target patients taking multiple medications.