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Potentially Inappropriate Medication Use in Older Patients in Swiss Managed Care Plans: Prevalence, Determinants and Association with Hospitalization

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  • Oliver Reich
  • Thomas Rosemann
  • Roland Rapold
  • Eva Blozik
  • Oliver Senn

Abstract

Objectives: To describe the prevalence and determinants of potentially inappropriate medication (PIM) use and association with hospitalizations in an elderly managed care population in Switzerland. Methods: Using health care claims data of four health insurers for a sample of managed care patients 65 years of age and older to compare persons on PIM with persons not on PIM. Beers' 2012 and PRISCUS criteria were used to determine the potential inappropriateness of prescribed medications. The sample included 16′490 elderly patients on PIM and 33′178 patients not on PIM in the time period of January 1, 2008 through December 31, 2012. Prevalence estimates are standardized to the population of Switzerland. Associations between PIM and hospitalizations were examined by multivariate Cox regression analyses controlling for possible confounding variables. Results: The estimated prevalence of PIM use in our managed care sample was 22.5%. Logistic regression analysis showed that number of different medications used in the previous year, total costs in the previous year and hospitalization in the previous year all significantly increased the likelihood of receiving PIM. Multiple Cox regression analysis revealed that those on cumulative levels of PIM use acted significantly as a factor related to greater hospitalization rates: the adjusted HR was 1.13 (95% CI 1.07–1.19) for 1 PIM, 1.27 (95% CI 1.19–1.35) for 2 PIM, 1.35 (95% CI 1.22–1.50) for 3 PIM, and 1.63 (95% CI 1.40–1.90) for more than 3 PIM compared to no PIM use. Conclusions: The prevalence of PIM in managed care health plans are widely found but seem to be much lower than rates of non-managed care plans. Furthermore, our study revealed a significant association with adverse outcomes in terms of hospitalizations. These findings stress the need for further development of interventions to decrease drug-related problems and manage patients with multiple chronic conditions.

Suggested Citation

  • Oliver Reich & Thomas Rosemann & Roland Rapold & Eva Blozik & Oliver Senn, 2014. "Potentially Inappropriate Medication Use in Older Patients in Swiss Managed Care Plans: Prevalence, Determinants and Association with Hospitalization," PLOS ONE, Public Library of Science, vol. 9(8), pages 1-9, August.
    • Handle: RePEc:plo:pone00:0105425
    DOI: 10.1371/journal.pone.0105425
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    References listed on IDEAS

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    1. Dedan Opondo & Saied Eslami & Stefan Visscher & Sophia E de Rooij & Robert Verheij & Joke C Korevaar & Ameen Abu-Hanna, 2012. "Inappropriateness of Medication Prescriptions to Elderly Patients in the Primary Care Setting: A Systematic Review," PLOS ONE, Public Library of Science, vol. 7(8), pages 1-9, August.
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    1. Virva Hyttinen & Johanna Jyrkkä & Leena K. Saastamoinen & Anna-Kaisa Vartiainen & Hannu Valtonen, 2019. "The association of potentially inappropriate medication use on health outcomes and hospital costs in community-dwelling older persons: a longitudinal 12-year study," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(2), pages 233-243, March.
    2. Chauvin, Pauline & Fustinoni, Sarah & Seematter-Bagnoud, Laurence & Herr, Marie & Santos Eggimann, Brigitte, 2021. "Potentially inappropriate prescriptions: Associations with the health insurance contract and the quality of the patient–physician relationship?," Health Policy, Elsevier, vol. 125(9), pages 1146-1157.
    3. Tzu-Chueh Wang & Pou-Jen Ku & Hai-Lin Lu & Kung-Chuan Hsu & Damien Trezise & Hue-Yu Wang, 2019. "Association between Potentially Inappropriate Medication Use and Chronic Diseases in the Elderly," IJERPH, MDPI, vol. 16(12), pages 1-12, June.

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