Potentially inappropriate prescribing for geriatric inpatients: an acute care of the elderly unit compared to a general medicine service.

Abstract

OBJECTIVE: To compare potentially inappropriate medication prescribing, as defined by the updated Beers criteria, in an acute care of the elderly (ACE) unit and a general medicine service. DESIGN: Non-concurrent cohort study of admitting and discharge summaries from an electronic medical record system. SETTING: A general medicine service and ACE unit at an 880-bed, tertiary care, teaching hospital. PARTICIPANTS: 176 patients from the ACE unit and 173 from the general medicine service who were 65 years of age or older, admitted after October 1, 1999, and discharged before February 29, 2000. MAIN OUTCOME MEASURE(S): Numbers of high- and low-severity potentially inappropriate medications (PIMs) and total medications on admission and discharge. RESULTS: The average number of all medications added on discharge was lower for the ACE unit versus general medicine service, 0.13 versus 0.75, respectively (P = .027). In the ACE unit, 11% of patients were prescribed PIMs with high-severity outcomes on discharge, either independent or dependent of diagnosis, compared with 12.7% in the general medicine service. The mean change in potentially inappropriate diagnoses independent medications upon discharge was - 0.09 in the ACE unit versus + 0.09 in the general medicine service (P = .011). CONCLUSION: Although detected differences were small, PIMs were less likely to be prescribed and more likely to be discontinued in the ACE unit. No differences were found in the majority of comparisons between groups.