Prevalence and incidence of potentially inappropriate medications prescribed to elderly Indiana Medicaid beneficiaries residing in nursing homes and associations with hospitalization and mortality
Abstract
The purpose of this study was to determine one-year prevalence and one-year incidence of potentially inappropriate medications (PIMs) prescribed to Indiana Medicaid beneficiaries aged 65 years or over and residing in nursing homes. Associations between PIM use and hospitalization and associations between PIM use and mortality were also examined. A retrospective database analysis was conducted using claims data from Indiana Family and Social Services Administration on Indiana Medicaid beneficiaries residing in nursing homes. The 2003 Beers criteria were used to identify potentially inappropriate medications prescribed to elderly nursing home residents. Individuals were included in the sample for prevalence estimates if they were Indiana Medicaid eligible, aged 65 years or over, received nursing home services from October 2002 through December 2003 or until death in 2003 and were prescribed at least one new medication during 2003. Individuals were included in the sample for incidence estimates if they were Indiana Medicaid eligible, aged 65 years or over, received nursing home services from October 2002 through December 2003 or until death in 2003, were prescribed at least one new medication in 2003 and did not receive any potentially inappropriate medications during the last quarter of 2002. Associations between PIM use and hospitalizations were assessed using claims for inpatient services during one year following receipt of a new medication. Mortality was assessed as death occurring during one year following receipt of a new medication. One-year prevalence of PIM use among elderly Indiana Medicaid beneficiaries residing in nursing homes was 68.9 percent. One-year incidence of PIM use among elderly Indiana Medicaid beneficiaries residing in nursing homes was 41.9 percent. Incident PIM use was more likely to occur among individuals receiving care in nursing facilities located in the southern region of Indiana, having higher Charlson comorbidity index scores and those receiving higher numbers of unique medications after adjusting for other demographic characteristics. Incidence PIM users were 28 percent more likely to be hospitalized during one year following receipt of a PIM than PIM non-users after adjusting for other demographic and clinical characteristics. PIM users were 16 percent more likely to die as compared to PIM non-users during one year following receipt of a new medication after adjusting for other demographic and clinical characteristics. In conclusion, prevalence and incidence of PIM prescribing is high among elderly Indiana Medicaid beneficiaries residing in nursing homes. Incident PIM use is associated with an increased risk of hospitalization and increased risk of dying.
Degree
Ph.D.
Advisors
Thomas, Purdue University.
Subject Area
Pharmaceuticals|Health care
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