Prevalence of inappropriate prescribing in complex chronic patients: Time trends in a health department of Valencia, Spain (2015-2019)

Abstract

Background and objective: Inappropriate prescribing (IP) is an important cause of health problems among elderly and complex chronic patients (CCPs).

Objective: Surveillance of IP prevalence among elderly and CCPs in a health department. IP time trends across the period 2015-2019.

Method: Descriptive population-based study.

Setting: 'València-Clínic-Malvarrosa' Health Department, Valencia, Spain.

Period: 2015-2019.

Subjects: Complete set of CCPs in the department, defined by clinical risk groups. Number of CCPs (annual average in the period): 9102 (75% ≥65 years of age). IP was measured using an indicator consisting of 13 specific types of prescriptions defined as inappropriate.

Analyses: frequencies and time trends, both overall and by specific type.

Results: Overall prevalence of IP ranged from 0.276 (2015) to 0.289 (2018) per patient, without time trend. The most frequent inappropriate prescription was type 1: "≥75 years of age with inappropriate medication", which showed a stable rate across the period. Some types of inappropriate prescriptions displayed favourable decreasing time trends, while others showed no change or an unfavourable trend (i.e., joint prescription of absorbents and urinary antispasmodics).

Conclusions: IP prevalence is a serious and persistent problem among the elderly and CCPs, especially in the oldest. It is therefore necessary its continuous surveillance (overall and by specific types of prescription). As well as interventions to optimise prescribing, thus improving the quality and efficiency of care for the elderly and CCPs.

Keywords: Complex chronic patients; Elderly; Inappropriate prescribing; Management information system; Pacientes crónicos complejos; Personas mayores; Prescripción inapropiada; Sistema de información para la gestión.