@article {17, title = {Prevalence and associations of potentially inappropriate prescriptions in Austrian nursing home residents: secondary analysis of a cross-sectional study.}, journal = {Wien Klin Wochenschr}, volume = {125}, year = {2013}, month = {2013 Apr}, pages = {180-8}, abstract = {

BACKGROUND: Potentially inappropriate prescriptions (PIP) are an important cause of adverse medication-related events and increases morbidity, hospitalization, and health care costs, especially in nursing home residents. However, little is known about the associations between PIP and residents{\textquoteright} characteristics.

OBJECTIVE: The aim of our study was to analyse the prevalence and associations of PIP with residents{\textquoteright} and facilities{\textquoteright} characteristics.

METHODS: We performed a secondary analysis of a cross-sectional study with 48 out of 50 eligible nursing homes and 1,844 out of 2,005 eligible residents in a defined rural-urban area in Austria. The Austrian list of potentially inappropriate medications was applied for the evaluation of inappropriate prescribing. Cluster-adjusted multiple regression analysis was used to investigate institutional and residents{\textquoteright} characteristics associated with PIP.

RESULTS: Mean cluster-adjusted prevalence of residents with at least one PIP was 70.3 \% (95 \% CI 67.2-73.4). The number of residents with at least one psychotropic PIP was 1.014 (55 \%). The most often prescribed PIP were Prothipendyl (25.9 \% residents), Lorazepam (14.5 \%) and Diclofenac (6.1 \%). Multiple regression analysis showed an inverse association of PIP with cognitive impairment and significant positive associations with permanent restlessness and permanent negative attitude. The associations of PIP with age and male gender were inconsistent. No significant associations were found for PIP and the ratio of staff nurses to residents.

CONCLUSIONS: Our study results confirm that PIP is highly prevalent in the nursing home population. These results urgently call for effective interventions. Initiatives and successful interventions performed in other countries could serve as examples for safer prescribing in residents in Austria.

}, keywords = {Adult, Age Distribution, Aged, Austria, Cognition Disorders, Comorbidity, Cross-Sectional Studies, Diclofenac, Female, Humans, Inappropriate Prescribing, Lorazepam, Male, Middle Aged, Nursing Care, Nursing Homes, Prescriptions, Prevalence, Psychomotor Agitation, Psychotropic Drugs, Risk Assessment}, issn = {1613-7671}, doi = {10.1007/s00508-013-0342-2}, author = {Mann, Eva and Haastert, Burkhard and B{\"o}hmdorfer, Birgit and Fr{\"u}hwald, Thomas and Iglseder, Bernhard and Roller-Wirnsberger, Regina and Meyer, Gabriele} } @article {19, title = {Potentially inappropriate medication in geriatric patients: the Austrian consensus panel list.}, journal = {Wien Klin Wochenschr}, volume = {124}, year = {2012}, month = {2012 Mar}, pages = {160-9}, abstract = {

BACKGROUND: The practice of inappropriate medication and drug prescription is a major risk factor for adverse drug reactions in geriatric patients and increases the individual, as well as overall, rates of hospital admissions, resulting in increased health care expenditures. A consensus-based list of drugs, generally to be avoided in geriatric patients, is a practical tool to possibly improve the quality of prescribing.

OBJECTIVE: The aim was to develop a consensus-based list of potentially inappropriate medications (PIM) for geriatric patients in Austria. Local market characteristics and documented prescribing regimens were considered in detail.

METHODS: A two-round Delphi process involving eight experts in the field of geriatric medicine was undertaken to create a list of potentially inappropriate medications. Using a 5-point Likert scale (from strong agreement to strong disagreement), mean ratings from the experts were evaluated for each drug selected in the first round. The participants were first asked to comment on the potential inappropriateness of a preliminary list of drugs, and to propose alternate substances missing in the previous questionnaire for a second rating process. All drugs whose upper limit of the 95\% CI was less than 3.0 were classified as potentially inappropriate. Drugs with a 95\% CI enclosing 3.0 entered a second rating by the experts, in addition to other substances suggested during the first questionnaire. Drugs in the second rating were evaluated in comparable fashion to the first one. The final list was synthesized from the results in both rounds.

RESULTS: Out of a preliminary list of 102 drugs, 61 drugs (59.2\%) were classified as potentially inappropriate for geriatric persons in the first Delphi- round. In the second rating, six drugs that were reevaluated, and six drugs proposed additionally, were rated as potentially inappropriate. The final list contains 73 drugs to be avoided in older patients because of an unfavorable benefit/risk profile and/or unproven effectiveness. The list also contains suggestions for therapeutic alternatives and information about pharmacological and pharmacokinetic characteristics of all drugs judged as potentially inappropriate.

CONCLUSION: The current Austrian list of potentially inappropriate medications may be a helpful tool for clinicians to increase the quality of prescribing in older patients. Like all explicit lists previously published, its validity needs to be proven in validation studies.

}, keywords = {Aged, Aged, 80 and over, Austria, Female, Humans, Inappropriate Prescribing, Male}, issn = {1613-7671}, doi = {10.1007/s00508-011-0061-5}, author = {Mann, Eva and B{\"o}hmdorfer, Birgit and Fr{\"u}hwald, Thomas and Roller-Wirnsberger, Regina E and Dovjak, Peter and D{\"u}ckelmann-Hofer, Christine and Fischer, Peter and Rabady, Susanne and Iglseder, Bernhard} }