Researchers in the University at Buffalo’s School of Pharmacy and Pharmaceutical Sciences wanted to know if older adults who are being prescribed inappropriate medications use healthcare services (emergency room visits, hospitalizations) more often — and how much more that is costing them. The researchers’ findings have drawn nationwide headlines.
Study: “Potentially Inappropriate Medications Are Associated With Increased Healthcare Utilization and Costs” (Journal of the American Geriatrics Society)
School of Pharmacy and Pharmaceutical Sciences research team: Collin M. Clark, PharmD, Clinical Assistant Professor, Department of Pharmacy Practice; David M. Jacobs, PharmD, PhD, Assistant Professor, Department of Pharmacy Practice; Robert G. Wahler, Jr., PharmD, Clinical Associate Professor, Department of Pharmacy Practice; Christopher J. Daly, PharmD, MBA, Clinical Assistant Professor, Department of Pharmacy Practice; Steven G. Feuerstein, Data Analyst, Department of Pharmacy Practice; Amy L. Shaver, PharmD, MPH; Leslie A. Aurelio, BS.
Study population (people whose information was included in the study): The study featured adults 65 years old or older in a survey called the “Medical Expenditure Panel Survey” from 2011-2015. There were 218,383,123 national survey respondents during the study period (2011–2015).
- 75,135,061 (34.4%) were prescribed at least one potentially inappropriate medication (PIM) and 143,248,062 (65.6%) were not prescribed any PIMs.
- The average age of the national survey respondents was 72 years old.
- Most were 65 to 74 years old, female, and white.
- Most had Medicare and private insurance coverage or Medicare only.
- A greater percentage of those prescribed PIMs reported below-average scores on the Physical and Mental Health Composite Scores for their age group, indicating that those exposed believed they were not in good health relative to others their age.
- National survey respondents who were possibly taking unnecessary medications had a higher number of medications prescribed to them, on average, than those who were not identified as possibly taking unnecessary medication.
- Comorbidities (the medical condition of two disorders or diseases or more coexisting at once) were more frequent in those prescribed PIMs.
- There were 25,217,427 hospitalizations and 31,103,344 emergency department visits in those prescribed PIMs.
- When looking at total costs — including inpatient hospitalizations, emergency department visits, outpatient, and prescription costs — patients who are identified as being prescribed PIMs are paying an additional $458 per year.
- Results suggest that PIM use is associated with an increased rate of healthcare utilization across the continuum of care.
- UB researchers found that PIM prescribing was highly prevalent in older adults and associated with increased healthcare utilization and expenditures.
- In conclusion, PIMs continue to be prescribed at high rates among older adults. Results suggest that PIM use is associated with increased healthcare utilization and costs across the healthcare continuum.
- Interventions are needed to target unnecessary and inappropriate medications in older adults. Deprescribing, in which a doctor actively stops medicines for a patient that are inappropriate or no longer needed, is increasingly receiving attention in the United States. Further work is needed to implement these interventions to reduce unnecessary healthcare utilization.
What does this all mean for patients?
It is important for you to advocate for yourself. Talk to your pharmacist and your primary care provider about all of your medications, and ask if the medications are all necessary and working well together.
“The number of medications a patient is prescribed increases as they age,” says study lead investigator David M. Jacobs, PharmD, PhD, “and it is important to continue to educate yourselves on these medications and ask questions to your providers and pharmacists about them.”
Interested in reading more about this study? Recent news articles:
Additional resources on deprescribing work being done at UB: