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Evaluation of appropriateness of drug prescriptions in the elderly and development of programs to improve it in Piedmont

Regione Piemonte

Azienda Ospedaliera Universitaria Maggiore della Carità, Novara & Università degli Studi del Piemonte Orientale, Dipartimento di Scienze del Farmaco, Novara

The exponential increase in the number of available pharmacological treatments for primary and specialty care in the elderly has increased the number of drugs that each individual is likely to be prescribed simultaneously. While on one hand this is likely to increase the quality (and length) of life of patients, it is now recognized that this might also lead to inappropriate prescriptions that might have the opposite effect.

The present proposal, by using multiple approaches, including pharmaco-epidemiological data coupled with outcome research, active pharmacovigilance, clinical governance represented by multidisciplinary working groups and pharmacogenetics wishes to analyze the phenomenon in depth in the Piedmont Region and provide appropriate tools to improve appropriate prescriptions.

The starting hypothesis is that part of the Italian elderly subject to poly-pharmacy treatments are at risk of inappropriate or deleterious prescriptions and that personalized measures across disciplines must be put in place to reduce risks.

The measures to be taken must, in our opinion, be determined in a data- and prescriber- and patient-driven process. Therefore, we plan to use administrative data (i.e. pharmaceutical reimbursement, hospital admissions and discharges), field investigations of drug use in long-term care facilities and field investigations on pharmacovigilance coupled to pharmacogenetics, to evaluate the current situation. This will then be followed by the use of the data by a multi-disciplinary working group to improve the quality of care of co-morbid out-patients and in assisted discharge.

The present proposal expects to:

• present a snapshot of drug use in the elderly in the Piedmont Region, implementing this with outcome research;
• compile an annotated list of inappropriate prescriptions that have been observed in real life;
• execute a pilot exploratory study to evaluate oral anticoagulant therapy and the impact of pharmacogenetics in predicting bleeding.

Reference facilities

A.O.U. Maggiore della Carità, Novara

Reference team

Scientific references

Prof. Armando Genazzani (Principal Investigator)