Potentially suboptimal prescribing of medicines for older Aboriginal Australians in remote areas

Amy Page, Zoë Hyde, Kate Smith, Christopher Etherton-Beer, David N. Atkinson, Leon Flicker, Linda Skeaf, Roslyn Malay, Dina C. LoGiudice

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Abstract

Objectives: To investigate the prevalence of polypharmacy, under-prescribing and potentially inappropriate medicine use among Aboriginal Australians living in remote Western Australia. Design: Cross-sectional study. Setting: Six remote communities and the town of Derby in the Kimberley, Western Australia. Participants: Aboriginal people aged 45 years or more with complete medication histories. Main outcome measures: Proportions of patients with medicine histories indicating polypharmacy, potential under-prescribing of indicated medicines, or potentially inappropriate prescribing (including potential prescribing cascades or drug interactions). Results: Complete medicine histories were available for 273 participants. The mean number of prescribed medicines was 5.1 (SD, 3.6). At least one form of suboptimal prescribing was identified for 166 participants (61%), including polypharmacy for 145 (53%), potential under-prescribing of at least one indicated medicine for 33 (12%), and potentially inappropriate prescribing for 54 participants (20%). Potential prescribing cascades or drug interactions were identified for 12 participants (4%). Conclusions: Potentially suboptimal prescribing affected more than half the participating older Aboriginal Australians from the Kimberley. If generalisable to other remote Indigenous Australians, the prevalence of polypharmacy, potentially inappropriate prescribing, and under-prescribing of indicated medicines is problematic, and suggests that older Indigenous people in remote areas are at risk of medicine-related harm.

Original languageEnglish
JournalMedical Journal of Australia
DOIs
Publication statusE-pub ahead of print - 12 Jun 2019

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Inappropriate Prescribing
Polypharmacy
History of Medicine
Western Australia
Medicine
Drug Interactions
Cross-Sectional Studies
Outcome Assessment (Health Care)

Cite this

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title = "Potentially suboptimal prescribing of medicines for older Aboriginal Australians in remote areas",
abstract = "Objectives: To investigate the prevalence of polypharmacy, under-prescribing and potentially inappropriate medicine use among Aboriginal Australians living in remote Western Australia. Design: Cross-sectional study. Setting: Six remote communities and the town of Derby in the Kimberley, Western Australia. Participants: Aboriginal people aged 45 years or more with complete medication histories. Main outcome measures: Proportions of patients with medicine histories indicating polypharmacy, potential under-prescribing of indicated medicines, or potentially inappropriate prescribing (including potential prescribing cascades or drug interactions). Results: Complete medicine histories were available for 273 participants. The mean number of prescribed medicines was 5.1 (SD, 3.6). At least one form of suboptimal prescribing was identified for 166 participants (61{\%}), including polypharmacy for 145 (53{\%}), potential under-prescribing of at least one indicated medicine for 33 (12{\%}), and potentially inappropriate prescribing for 54 participants (20{\%}). Potential prescribing cascades or drug interactions were identified for 12 participants (4{\%}). Conclusions: Potentially suboptimal prescribing affected more than half the participating older Aboriginal Australians from the Kimberley. If generalisable to other remote Indigenous Australians, the prevalence of polypharmacy, potentially inappropriate prescribing, and under-prescribing of indicated medicines is problematic, and suggests that older Indigenous people in remote areas are at risk of medicine-related harm.",
keywords = "Aging, Chronic disease, Indigenous health, Prescribing, Prescription drugs, Rural health services",
author = "Amy Page and Zo{\"e} Hyde and Kate Smith and Christopher Etherton-Beer and Atkinson, {David N.} and Leon Flicker and Linda Skeaf and Roslyn Malay and LoGiudice, {Dina C.}",
year = "2019",
month = "6",
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language = "English",
journal = "Medical Journal Australia",
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T1 - Potentially suboptimal prescribing of medicines for older Aboriginal Australians in remote areas

AU - Page, Amy

AU - Hyde, Zoë

AU - Smith, Kate

AU - Etherton-Beer, Christopher

AU - Atkinson, David N.

AU - Flicker, Leon

AU - Skeaf, Linda

AU - Malay, Roslyn

AU - LoGiudice, Dina C.

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Y1 - 2019/6/12

N2 - Objectives: To investigate the prevalence of polypharmacy, under-prescribing and potentially inappropriate medicine use among Aboriginal Australians living in remote Western Australia. Design: Cross-sectional study. Setting: Six remote communities and the town of Derby in the Kimberley, Western Australia. Participants: Aboriginal people aged 45 years or more with complete medication histories. Main outcome measures: Proportions of patients with medicine histories indicating polypharmacy, potential under-prescribing of indicated medicines, or potentially inappropriate prescribing (including potential prescribing cascades or drug interactions). Results: Complete medicine histories were available for 273 participants. The mean number of prescribed medicines was 5.1 (SD, 3.6). At least one form of suboptimal prescribing was identified for 166 participants (61%), including polypharmacy for 145 (53%), potential under-prescribing of at least one indicated medicine for 33 (12%), and potentially inappropriate prescribing for 54 participants (20%). Potential prescribing cascades or drug interactions were identified for 12 participants (4%). Conclusions: Potentially suboptimal prescribing affected more than half the participating older Aboriginal Australians from the Kimberley. If generalisable to other remote Indigenous Australians, the prevalence of polypharmacy, potentially inappropriate prescribing, and under-prescribing of indicated medicines is problematic, and suggests that older Indigenous people in remote areas are at risk of medicine-related harm.

AB - Objectives: To investigate the prevalence of polypharmacy, under-prescribing and potentially inappropriate medicine use among Aboriginal Australians living in remote Western Australia. Design: Cross-sectional study. Setting: Six remote communities and the town of Derby in the Kimberley, Western Australia. Participants: Aboriginal people aged 45 years or more with complete medication histories. Main outcome measures: Proportions of patients with medicine histories indicating polypharmacy, potential under-prescribing of indicated medicines, or potentially inappropriate prescribing (including potential prescribing cascades or drug interactions). Results: Complete medicine histories were available for 273 participants. The mean number of prescribed medicines was 5.1 (SD, 3.6). At least one form of suboptimal prescribing was identified for 166 participants (61%), including polypharmacy for 145 (53%), potential under-prescribing of at least one indicated medicine for 33 (12%), and potentially inappropriate prescribing for 54 participants (20%). Potential prescribing cascades or drug interactions were identified for 12 participants (4%). Conclusions: Potentially suboptimal prescribing affected more than half the participating older Aboriginal Australians from the Kimberley. If generalisable to other remote Indigenous Australians, the prevalence of polypharmacy, potentially inappropriate prescribing, and under-prescribing of indicated medicines is problematic, and suggests that older Indigenous people in remote areas are at risk of medicine-related harm.

KW - Aging

KW - Chronic disease

KW - Indigenous health

KW - Prescribing

KW - Prescription drugs

KW - Rural health services

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