Prevalence and predictors of sub-optimal laboratory monitoring of selected higher risk medicines in Irish general practice: a 5-year retrospective cohort study of community-dwelling older adults
Objectives To describe the prevalence of sub-optimal monitoring for selected higher-risk medicines in older community-dwelling adults and to evaluate patient characteristics and outcomes associated with sub-optimal monitoring.Study design Retrospective observational study (2011–2015) using historica...
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/1/e086446.full |
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| author | Fiona Boland Emma Wallace Frank Moriarty Tom Fahey Caroline McCarthy Ann Sinéad Doherty Mark Feighery |
| author_facet | Fiona Boland Emma Wallace Frank Moriarty Tom Fahey Caroline McCarthy Ann Sinéad Doherty Mark Feighery |
| author_sort | Fiona Boland |
| collection | DOAJ |
| description | Objectives To describe the prevalence of sub-optimal monitoring for selected higher-risk medicines in older community-dwelling adults and to evaluate patient characteristics and outcomes associated with sub-optimal monitoring.Study design Retrospective observational study (2011–2015) using historical general practice-based cohort data and linked dispensing data from a national pharmacy claims database.Setting Irish primary care.Participants 625 community-dwelling adults aged ≥70 years and prescribed at least one higher-risk medicine during the 5-year study period.Primary and secondary outcome measures The primary outcome was the prevalence of sub-optimal laboratory monitoring using a composite measure of published medication monitoring indicators, with a focus on commonly prescribed higher-risk medicines such as diuretics and anticoagulants. Poisson regression was used to assess the patient characteristics associated with sub-optimal monitoring and explanatory variables included the number of medicines, age, sex, deprivation and anxiety/depression symptoms. Logistic regression was used to explore the association between baseline sub-optimal monitoring and the odds of adverse health outcomes (unplanned healthcare utilisation, adverse drug reactions and mortality).Results Of 625 participants, the mean age was 77.7 years, 53% were female, the mean number of drugs was 7.3 (SD 3.3) and 499 (79.8%) had ≥1 unmonitored dispensing over 5 years. The number of drugs, deprivation and anxiety/depression symptoms were significantly associated with sub-optimal monitoring, with the strongest association seen for anxiety/depression symptoms (incidence rate ratio: 1.33, 95% CI 1.05 to 1.68). There was a small but significant association between baseline sub-optimal monitoring and emergency department visits at follow-up, but no evidence of an association with unplanned hospital admissions, mortality or adverse drug reactions.Conclusion The prevalence of sub-optimal medication monitoring was high, and number of drugs, deprivation and anxiety/depression symptoms were significantly associated with sub-optimal monitoring. However, the public health impact of these findings remains uncertain, as there was no clear evidence of an association between sub-optimal monitoring and adverse health outcomes. Further research is needed to evaluate the effect of improved monitoring strategies and the optimal timing for drug monitoring of higher risk medications. |
| format | Article |
| id | doaj-art-77ccba834bae423abe03658590e69a90 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-77ccba834bae423abe03658590e69a902025-01-27T09:30:10ZengBMJ Publishing GroupBMJ Open2044-60552025-01-0115110.1136/bmjopen-2024-086446Prevalence and predictors of sub-optimal laboratory monitoring of selected higher risk medicines in Irish general practice: a 5-year retrospective cohort study of community-dwelling older adultsFiona Boland0Emma Wallace1Frank Moriarty2Tom Fahey3Caroline McCarthy4Ann Sinéad Doherty5Mark Feighery6Data Science Centre, Royal College of Surgeons Ireland (RCSI) University of Medicine and Health Sciences, Dublin, IrelandData and Analysis for Social Care and Health Division, Office for National Statistics, Newport, UK3 School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland1 Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland4 Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USADepartment of General Practice, University College Cork, Cork, IrelandDepartment of General Practice, University College Cork, Cork, IrelandObjectives To describe the prevalence of sub-optimal monitoring for selected higher-risk medicines in older community-dwelling adults and to evaluate patient characteristics and outcomes associated with sub-optimal monitoring.Study design Retrospective observational study (2011–2015) using historical general practice-based cohort data and linked dispensing data from a national pharmacy claims database.Setting Irish primary care.Participants 625 community-dwelling adults aged ≥70 years and prescribed at least one higher-risk medicine during the 5-year study period.Primary and secondary outcome measures The primary outcome was the prevalence of sub-optimal laboratory monitoring using a composite measure of published medication monitoring indicators, with a focus on commonly prescribed higher-risk medicines such as diuretics and anticoagulants. Poisson regression was used to assess the patient characteristics associated with sub-optimal monitoring and explanatory variables included the number of medicines, age, sex, deprivation and anxiety/depression symptoms. Logistic regression was used to explore the association between baseline sub-optimal monitoring and the odds of adverse health outcomes (unplanned healthcare utilisation, adverse drug reactions and mortality).Results Of 625 participants, the mean age was 77.7 years, 53% were female, the mean number of drugs was 7.3 (SD 3.3) and 499 (79.8%) had ≥1 unmonitored dispensing over 5 years. The number of drugs, deprivation and anxiety/depression symptoms were significantly associated with sub-optimal monitoring, with the strongest association seen for anxiety/depression symptoms (incidence rate ratio: 1.33, 95% CI 1.05 to 1.68). There was a small but significant association between baseline sub-optimal monitoring and emergency department visits at follow-up, but no evidence of an association with unplanned hospital admissions, mortality or adverse drug reactions.Conclusion The prevalence of sub-optimal medication monitoring was high, and number of drugs, deprivation and anxiety/depression symptoms were significantly associated with sub-optimal monitoring. However, the public health impact of these findings remains uncertain, as there was no clear evidence of an association between sub-optimal monitoring and adverse health outcomes. Further research is needed to evaluate the effect of improved monitoring strategies and the optimal timing for drug monitoring of higher risk medications.https://bmjopen.bmj.com/content/15/1/e086446.full |
| spellingShingle | Fiona Boland Emma Wallace Frank Moriarty Tom Fahey Caroline McCarthy Ann Sinéad Doherty Mark Feighery Prevalence and predictors of sub-optimal laboratory monitoring of selected higher risk medicines in Irish general practice: a 5-year retrospective cohort study of community-dwelling older adults BMJ Open |
| title | Prevalence and predictors of sub-optimal laboratory monitoring of selected higher risk medicines in Irish general practice: a 5-year retrospective cohort study of community-dwelling older adults |
| title_full | Prevalence and predictors of sub-optimal laboratory monitoring of selected higher risk medicines in Irish general practice: a 5-year retrospective cohort study of community-dwelling older adults |
| title_fullStr | Prevalence and predictors of sub-optimal laboratory monitoring of selected higher risk medicines in Irish general practice: a 5-year retrospective cohort study of community-dwelling older adults |
| title_full_unstemmed | Prevalence and predictors of sub-optimal laboratory monitoring of selected higher risk medicines in Irish general practice: a 5-year retrospective cohort study of community-dwelling older adults |
| title_short | Prevalence and predictors of sub-optimal laboratory monitoring of selected higher risk medicines in Irish general practice: a 5-year retrospective cohort study of community-dwelling older adults |
| title_sort | prevalence and predictors of sub optimal laboratory monitoring of selected higher risk medicines in irish general practice a 5 year retrospective cohort study of community dwelling older adults |
| url | https://bmjopen.bmj.com/content/15/1/e086446.full |
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