Doctors prescribe high-risk medications to over one-fifth of elderly patients in the United States, with higher prescription rates found in the Southeast, according to a new study by University researchers.
The paper was published in the Journal of General Internal Medicine earlier this month.
To conduct the study, co-authors Amal Trivedi, assistant professor of community health, and Danya Qato GS, a doctoral candidate in community health, combed through the demographic data of 6.2 million patients enrolled in Medicare Advantage health plans in 2009.
More than 1.3 million seniors — 21.5 percent of patients — were prescribed one high-risk medication, with 5 percent receiving two or more prescriptions, Qato said.
High-risk medications should be avoided, Trivedi said, because “it’s likely that the harm outweighs the benefits.” Safer alternatives are usually available, he added.
Around 100 medications are classified as high-risk for seniors, according to the National Committee for Quality Assurance. Most of these commonly prescribed drugs carry few side effects in younger patients, Qato said.
The drugs include anti-anxiety and antihistamine medications such as Equanil and Benadryl as well as oral estrogens.
Americans living in the Southeast are 10 to 12 percent more likely to be prescribed high-risk medications than patients in the Northeast, the study found. Similarly, the 20 worst-performing hospital referral regions are located in the Southeast.
“I was struck by the scope of geographic variation,” Trivedi said. “That’s important from a policy perspective. It suggests that we should focus on areas of the country where rates are much higher.”
A number of interconnected factors may explain the geographic differences, including different prescibing cultures, a higher prevalence of chronic conditions in the area and “a lower quality of care in the South in general,” Qato said.
Women, lower-income individuals and whites were also more likely to receive high-risk medication, the paper stated.
Women are prescribed high-risk medication at greater rates because some of the classified medications, such as oral estrogens, are prescribed only to women, the authors wrote in the study. But even after controlling for gender-related variables, “women were still at higher risk,” Qato said.
Despite the findings, doctors continue to prescribe high-risk medications, and patients are unaware of the risks, Trivedi said.
Doctors often prescribe the medications without being fully aware of the dangerous side effects, he added. “Changing provider behavior is a difficult proposition. The necessary first step is to provide information and lay out the scope of the problem,” he said.
There also remains “the need to further emphasize medication management of geriatric patients in clinical training,” the authors wrote.
As a pharmacist, Qato emphasized the study’s importance in empowering patients by giving them knowledge about their medication therapies. But doctors and legislators need to take the next step, she said. “It’s a call to action for clinicians and policy makers to take this variation seriously,” Qato said.
“It’s about the patient acknowledging that they’re participants in an imperfect health care system. They can be active participants in shaping their health care.”
ADVERTISEMENT
