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Longitudinal evaluation of medication underuse in older outpatients and its association with quality of life

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

We investigated the factors promoting prescribing omissions (medication underuse) in long-term medical care and the impact of withholding indicated medications on quality of life.

Methods

In a population-based cohort study of older ambulatory patients (ESTHER), we collected data with sequential questionnaires from participants and from their GPs. Concurrently, in two consecutive home visits, trained study physicians performed comprehensive geriatric assessments and recorded all medicines currently taken. Each patient’s medication was screened for underuse using the START-2 criteria.

Results

Medication underuse (absence of ≥1 indicated medication) was present in 70.3 and 73.2 % of 989 participants at two consecutive home visit assessments, respectively. Following variable selection accounting for subject-specific heterogeneity over time, multivariate results revealed that more drugs (odds ratio with 95 % confidence intervals: 0.83 [0.78;0.87] per drug) and better cognitive status (0.93 [0.87;0.99] per point on the MMSE scale) were preventive factors, while worse self-reported health status (1.33 [1.05;1.67] per point on an 5-point scale) and increasing frequency of GP consultations (1.07 [1.00;1.15] per visit within the preceding 3 months) were positively associated with medication underuse. An increase in omitted medications over time was associated with worse quality of life as determined on the EuroQuol EQ-Vas and EQ-5D scales.

Conclusion

In addition to general and physician-related factors, also patient-related aspects, such as individual health appraisal, were associated with medication underuse. Because withholding indicated drugs was associated with substantially reduced quality of life, controlled intervention studies are necessary to confirm the notion that pharmacological appropriateness improves personal wellbeing.

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Acknowledgments

This work was supported in part by the German Federal Ministry of Education and Research (BMBF, Berlin, Germany) under Grant Numbers 01ET0717, 01ET1004B, and 01GY1320B. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author’s contribution

AMD and WEH substantially contributed to conception, design, analysis, and interpretation of the data of the study as well as writing of the manuscript. AG substantially contributed to the analysis and interpretation of the data and the preparation of the manuscript and critically revised the manuscript. HB designed and led the ESTHER study from its beginning. WEH, HHK, and BW substantially contributed to conception of the ESTHER study and critically revised the manuscript. KUS, BS, BW, DH, and HB contributed to conception and conduct of the data collection and critically revised the manuscript. All authors had full access to study data and approved the final version before publication.

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Authors and Affiliations

  1. Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Andreas D. Meid, Renate Quinzler & Walter E. Haefeli

  2. Department of Mathematics, Ludwig-Maximilians-University Munich, Theresienstr. 39, 80333, Munich, Germany

    Andreas Groll

  3. Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Beate Wild

  4. Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany

    Kai-Uwe Saum, Ben Schöttker & Hermann Brenner

  5. Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Dirk Heider & Hans-Helmut König

  6. Network Aging Research, University of Heidelberg, Bergheimer Straße 20, 69120, Heidelberg, Germany

    Hermann Brenner

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  1. Andreas D. Meid
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  2. Renate Quinzler
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  3. Andreas Groll
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  10. Walter E. Haefeli
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Correspondence to Walter E. Haefeli.

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Meid, A.D., Quinzler, R., Groll, A. et al. Longitudinal evaluation of medication underuse in older outpatients and its association with quality of life. Eur J Clin Pharmacol 72, 877–885 (2016). https://doi.org/10.1007/s00228-016-2047-8

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  • DOI: https://doi.org/10.1007/s00228-016-2047-8

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