Skip to main content
Log in

A Meta-Synthesis of Potentially Inappropriate Prescribing in Older Patients

  • Original Research Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Background

Potentially inappropriate prescribing (PIP) is commonly seen amongst the older population in all clinical settings, as indicated by several prevalence studies in several countries. Quantitative work such as this confirms that this is a global public health problem likely to grow in tandem with ageing of the global population. However, less attention has been focused on why it is happening and how it can be prevented.

Objective

The objective of this paper is to synthesise qualitative studies that explore PIP in older patients, in an effort to understand why it happens from a prescriber’s perspective and to generate a new theory to guide future interventional studies aimed at minimising it in older people. To date, there is no published systematic synthesis of this type.

Methods

Papers were deemed suitable for inclusion if they used qualitative methods, explored some area of PIP in patients over 65 years of age, were published in English and had available published abstracts. Four databases were systematically searched for papers published up to the end of April 2013: PubMed, Embase, CINAHL and Web of Knowledge. No date restrictions were applied. Key words searched were: Qualitative AND (Inappropriate* OR Appropriate* OR Safe) AND (Elderly OR Aged OR Geriatric* OR Old*) AND Prescri*. Reference lists were then searched for other suitable papers. Critical Appraisal Skills Programme criteria were used to assess quality. Meta-ethnography was used to synthesise the papers.

Results

Out of 624 papers identified, seven papers were deemed relevant. Four key concepts were identified as being causal factors in PIP: (1) the need to please the patient, (2) feeling of being forced to prescribe, (3) tension between prescribing experience and prescribing guidelines and (4) prescriber fear. These were re-interpreted in a line of argument synthesis indicating that some doctors have self-perceived restrictions with regard to prescribing appropriately because of a combination of factors, rather than any one dominant factor.

Conclusion

Prevention of PIP may be favourably influenced by addressing the key interactive determinants of inappropriate prescribing behaviour.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig.1
Fig.2

Similar content being viewed by others

References

  1. Ryan C, O’Mahony D, Kennedy J, et al. Potentially inappropriate prescribing in an Irish elderly population in primary care. Br J Clin Pharmacol. 2009;68(6):936–47.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Dunn RL, Harrison D, Ripley TL. The Beers criteria as an outpatient screening tool for potentially inappropriate medications. Consult Pharm. 2011;26(10):754–63.

    Article  PubMed  Google Scholar 

  3. Spiker EC, Emptage RE, Giannamore MR, et al. Potential adverse drug events in an indigent and homeless geriatric population. Ann Pharmacother. 2001;35(10):1166–72.

    Article  CAS  PubMed  Google Scholar 

  4. Gallagher P, Lang PO, Cherubini A, et al. Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals. Eur J Clin Pharmacol. 2011;67(11):1175–88.

    Article  PubMed  Google Scholar 

  5. O’Connor MN, Gallagher P, O’Mahony D. Inappropriate prescribing: criteria, detection and prevention. Drugs Aging. 2012;29(6):437–52.

    Article  PubMed  Google Scholar 

  6. O’Sullivan DP, O’Mahony D, Parsons C, et al. A prevalence study of potentially inappropriate prescribing in Irish long-term care residents. Drugs Aging. 2013;30(1):39–49.

    Article  PubMed  Google Scholar 

  7. Lund BC, Carnahan RM, Egge JA, et al. Inappropriate prescribing predicts adverse drug events in older adults. Ann Pharmacother. 2010;44(6):957–63.

    Article  PubMed  Google Scholar 

  8. Chrischilles EA, VanGilder R, Wright K, et al. Inappropriate medication use as a risk factor for self-reported adverse drug. J Am Geriatr Soc. 2009;57(6):1000–6.

    Article  PubMed  Google Scholar 

  9. Passarelli MC, Jacob-Filho W, Figueras A. Adverse drug reactions in an elderly hospitalised population: inappropriate prescription is a leading cause. Drugs Aging. 2005;22(9):767–77.

    Article  PubMed  Google Scholar 

  10. Noblit GW, Hare RD. Meta-ethnography: synthesising qualitative studies. New York: Sage; 1988.

    Google Scholar 

  11. Campbell R, Pound P, Pope C, et al. Evaluating meta-ethnography: a synthesis of qualitative research on lay experiences of diabetes and diabetes care. Soc Sci Med. 2003;56(4):671–84.

    Article  PubMed  Google Scholar 

  12. Campbell R, Pound P, Morgan M, et al. Evaluating meta-ethnography: systematic analysis and synthesis of qualitative research. Health Technol Assess. 2011;15(43):1–164.

    CAS  PubMed  Google Scholar 

  13. Atkins S, Lewin S, Smith H, et al. Conducting a meta-ethnography of qualitative literature: lessons learnt. BMC Med Res Methodol. 2008;16(8):21.

    Article  Google Scholar 

  14. Malpass A, Shaw A, Sharp D, et al. “Medication career” or “moral career”? The two sides of managing antidepressants: a meta-ethnography of patients’ experience of antidepressants. Soc Sci Med. 2009;68(1):154–68.

    Article  PubMed  Google Scholar 

  15. Pound P, Britten N, Morgan M, et al. Resisting medicines: a synthesis of qualitative studies of medicine taking. Soc Sci Med. 2005;61(1):133–55.

    Article  PubMed  Google Scholar 

  16. Britten N, Campbell R, Pope C, et al. Using meta ethnography to synthesise qualitative research: a worked example. J Health Serv Res Policy. 2002;7(4):209–15.

    Article  PubMed  Google Scholar 

  17. Teixeira Rodrigues A, Roque F, Falcao A, et al. Understanding physician antibiotic prescribing behaviour: a systematic review of qualitative studies. Int J Antimicrob Agents. 2013;41(3):203–12.

    Article  CAS  PubMed  Google Scholar 

  18. Thorne S, Jensen L, Kearney MH, et al. Qualitative metasynthesis: reflections on methodological orientation and idealogical agenda. Qual Health Res. 2004;14(10):1342–65.

    Article  PubMed  Google Scholar 

  19. Tong A, Flemming K, McInnes E, et al. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol. 2012;27(12):181.

    Article  Google Scholar 

  20. Dickinson R, Knapp P, House AO, et al. Long-term prescribing of antidepressants in the older population: a qualitative study. Br J Gen Pract. 2010;60(573):257–9.

    Article  Google Scholar 

  21. Agarwal G, Nair K, Cosby J, et al. GPs’ approach to insulin prescribing in older patients: a qualitative study. Br J Gen Pract. 2008;58(553):569–75.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Spitz A, Moore AA, Papaleontiou M, et al. Primary care providers’ perspective on prescribing opioids to older adults with chronic non-cancer pain: a qualitative study. BMC Geriatr. 2011;14(11):35.

    Article  Google Scholar 

  23. Cook JM, Marshall R, Masci C, et al. Physicians’ perspectives on prescribing benzodiazepines for older adults: a qualitative study. J Gen Intern Med. 2007;22(3):303–7.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Salzman C, The APA. Task Force report on benzodiazepine dependence, toxicity, and abuse. Am J Psychiatry. 1991;148(2):151–2.

    CAS  PubMed  Google Scholar 

  25. Consensus conference. Drugs and insomnia: the use of medications to promote sleep. JAMA. 1984;251(18):2410–4.

  26. Damestoy N, Collin J, Lalande R. Prescribing psychotropic medication for elderly patients: some physicians’ perspectives. CMAJ. 1999;161(2):143–5.

    CAS  PubMed Central  PubMed  Google Scholar 

  27. Wood-Mitchell A, James IA, Waterworth A, et al. Factors influencing the prescribing of medications by old age psychiatrists for behavioural and psychological symptoms of dementia: a qualitative study. Age Ageing. 2008;37(5):547–52.

    Article  PubMed  Google Scholar 

  28. Spinewine A, Swine C, Dhillon S, et al. Appropriateness of use of medicines in elderly inpatients: qualitative study. BMJ. 2005;331(7522):935–8.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Gordon M. Non-technical skills training to enhance patient safety. Clin Teach. 2013;10(3):170–5.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to acknowledge the Health Research Board of Ireland for funding this research (Grant no. HRA_HSR/2010/14). The manuscript does not contain clinical studies or patient data.

Conflict of interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Shane Cullinan.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cullinan, S., O’Mahony, D., Fleming, A. et al. A Meta-Synthesis of Potentially Inappropriate Prescribing in Older Patients. Drugs Aging 31, 631–638 (2014). https://doi.org/10.1007/s40266-014-0190-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-014-0190-4

Keywords

Navigation