Assessing Potentially Inappropriate Prescribing (PIP) and Predicting Patient Outcomes in Ontario's Elderly Population Using the Modified STOPP Criteria in Large Administrative Health Databases (the PIP-STOPP Study)
试验速览
- 阶段
- 不适用
- 发起方
- 入组人数
- 2,000,000
- 主要终点
- Time to any outcome
研究概览
简要总结
The overall objective of the present study will be to describe the occurrence of Potentially Inappropriate Prescribing (PIP) in Ontario's elderly (>65 yrs) population, assess the health and economic burden associated with it, and evaluate interventions aimed at mitigating its effects.
To attain this objective, the investigators will test three specific hypotheses:
Hypothesis 1: Instances of Potentially Inappropriate Prescribing are frequent and costly. To test this hypothesis, the investigators will apply a subset of the STOPP criteria and Beers criteria to Ontario health administrative data to identify instances of potentially inappropriate prescribing, and estimate potential savings, both direct and indirect, that could be achieved by reducing inappropriate prescribing.
Hypothesis 2: ED visits and hospitalizations are significantly associated with Potentially Inappropriate Prescribing. To test this hypothesis, the investigators will estimate the attributable fraction of ER visits and hospitalizations associated with different frequencies of PIP using multivariate methods and survival analysis.
Hypothesis 3: The likelihood of inappropriate prescribing is associated with patient and physician characteristics. To test this hypothesis, the investigators will identify each physician's annual PIP incidence density, calculated by dividing the number of PIP they issued by the total number of prescriptions they provided over the study period and then explore the association of patient and physician level covariates with patient outcomes.
The investigators will test these hypotheses in the framework of a retrospective cohort study which the investigators will conduct using Ontario's large health administrative and population databases. These are housed at the Institute for Clinical Evaluative Sciences (ICES) and contain information on both hospital and outpatient use of health services, as well as demographic and socioeconomic data. Patients included in the study will be all OHIP (Ontario Health Insurance Plan) eligible patients aged 66 yrs of age and older who have been issued at least one prescription between April 1st 2003 and March 31st 2013.
The investigator team, housed at ICES@uOttawa, has extensive experience and expertise with the analysis of these databases, and has the support and resources necessary to successfully carry out this study.
详细描述
Objective: The overall objective of the study will be to describe the occurrence of Potentially Inappropriate Prescribing (PIP) in Ontario's elderly (>65 years) population, assess the health and economic burden associated with it, and evaluate interventions aimed at mitigating its effects.
Hypothesis 1: Instances of Potentially Inappropriate Prescribing are frequent and costly.
To test this hypothesis, the investigators will apply a subset of the STOPP criteria and Beers criteria to Ontario health administrative data to identify instances of potentially inappropriate prescribing, and estimate potential savings, both direct and indirect, which could be achieved by reducing inappropriate prescribing.
Hypothesis 2: ED visits and hospitalizations are significantly associated with Potentially Inappropriate Prescribing
To test this hypothesis, the investigators will estimate the attributable fraction of ER visits and hospitalizations associated with different frequencies of PIP using multivariate methods and survival analysis.
研究设计
- 研究类型
- Observational
- 时间视角
- Retrospective
入排标准
- 年龄范围
- 66 Years 至 —（Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Individuals eligible for participation in the study will include all patients who were:
- •continuously eligible for OHIP (Ontario Health Insurance Plan) coverage,
- •issued at least one prescription (of any type) during the accrual period (between April 1st, 2003 and March 31st, 2013),
- •66 years of age or older at the date of first dispensation during the accrual period; this is necessary to ensure the availability of one year of background information on medication and health services use for all patients.
排除标准
- •Patients will be excluded if:
- •They do not have a valid OHIP number. This includes individuals whose health care is provided by other plans (e.g. First Nations people living on reserves, members of the Canadian Armed Forces, and refugee claimants) and is therefore not captured by ICES data.
- •Patients will also be excluded if they were not OHIP-eligible for at least one year prior to the index date, or one year after the index date, or if they do not have continuous OHIP coverage between these two dates; this is necessary to ensure that predictors and outcomes of PIP can be adequately captured.
- •Patients not dispensed any prescription medication will not be included in the study.
结局指标
主要结局
Time to any outcome
时间窗: Up to 90 days after index date
Time between first PIP and first of ER visit, hospitalization or death, occurring within the time window for 'PIP relevant outcomes' (usually up to 3 months after an instance of PIP, but may be longer for some criteria)
次要结局
- Time to hospitalization(Up to 90 days after index date)
- Time to ER visit(Up to 90 days after index date)
- Time to death(Up to 90 days after index date)
研究者
Lise Bjerre
Clinician-Investigator
Bruyere Research Institute