BMJ open · 2026
Is potentially inappropriate prescribing in UK middle-aged adults associated with healthcare utilisation and mortality? A prospective cohort study of a 1.2 million patient cohort conducted in the clinical practice research datalink.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Naughton Michael, Molokhia Mariam, Redmond Patrick, Douglas Ian J, Mathur Rohini
Аннотация
OBJECTIVES: To estimate the prevalence of potentially inappropriate prescribing (PIP) in UK middle-aged adults, identify patient-level factors associated with PIP and its associations with subsequent primary care utilisation and mortality.
DESIGN: A prospective observational cohort study.
SETTING: English routinely collected primary care electronic health record data from the Clinical Practice Research Datalink Aurum. The follow-up period was from 1 January 2018 to 7 February 2023.
PARTICIPANTS: Randomly selected individuals (n=1 200 000) who were aged 45-64 years on 1 January 2018.
EXPOSURE: Exposure was defined as at least one episode of PIP in the year 2018.
PRIMARY AND SECONDARY OUTCOMES: The primary outcome was the rate of GP consultations in the year following exposure (2019). The secondary outcome was mortality between 2019 and 2023.
RESULTS: 13.9% of participants experienced PIP in 2018. Factors significantly associated with PIP included polypharmacy (≥10 medications: OR 6.93, 95% CI 6.61 to 7.27), multimorbidity (OR 2.47, 95% CI 2.45 to 2.50), female sex (OR 1.14, 95% CI 1.13 to 1.16), older age (OR 1.01 95% CI 1.01 to 1.02) and higher primary care consultation frequency (OR 1.04 95% CI 1.04 to 1.04). PIP was associated with increased primary care consultations the following year (IRR 1.03, 95% CI 1.02 to 1.03) but not mortality (HR 0.99, 95% CI 0.93 to 1.04).
CONCLUSION: One in seven middle-aged adults were exposed to PIP and PIP resulted in higher subsequent primary care consultations; medicine optimisation strategies for PIP warrant evaluation in middle aged adults.
DESIGN: A prospective observational cohort study.
SETTING: English routinely collected primary care electronic health record data from the Clinical Practice Research Datalink Aurum. The follow-up period was from 1 January 2018 to 7 February 2023.
PARTICIPANTS: Randomly selected individuals (n=1 200 000) who were aged 45-64 years on 1 January 2018.
EXPOSURE: Exposure was defined as at least one episode of PIP in the year 2018.
PRIMARY AND SECONDARY OUTCOMES: The primary outcome was the rate of GP consultations in the year following exposure (2019). The secondary outcome was mortality between 2019 and 2023.
RESULTS: 13.9% of participants experienced PIP in 2018. Factors significantly associated with PIP included polypharmacy (≥10 medications: OR 6.93, 95% CI 6.61 to 7.27), multimorbidity (OR 2.47, 95% CI 2.45 to 2.50), female sex (OR 1.14, 95% CI 1.13 to 1.16), older age (OR 1.01 95% CI 1.01 to 1.02) and higher primary care consultation frequency (OR 1.04 95% CI 1.04 to 1.04). PIP was associated with increased primary care consultations the following year (IRR 1.03, 95% CI 1.02 to 1.03) but not mortality (HR 0.99, 95% CI 0.93 to 1.04).
CONCLUSION: One in seven middle-aged adults were exposed to PIP and PIP resulted in higher subsequent primary care consultations; medicine optimisation strategies for PIP warrant evaluation in middle aged adults.