Patient- and clinic visit-related factors associated with potentially inappropriate medication use among older home healthcare service recipients

Taiwanese National Health Insurance (TNHI) provides home healthcare services to patients with skilled nursing needs who were homebound or lived in nursing homes. Studies on potentially inappropriate medications (PIMs) for older home healthcare service recipients (HHSRs) are growing, but comparisons among newer criteria of PIMs have not been applied. The aim of this study was to explore the prevalence and correlates of PIMs based on three different instruments published after 2010 among older HHSRs. We performed cross-sectional analysis of the TNHI Research Database. A total of 25,187 HHSRs aged more than 65 years in 2009 were included. Medication lists independent of chronic conditions from the 2012 Beers criteria, PIM-Taiwan criteria, and the PRISCUS (Latin for "old and venerable") criteria were used. Analysis was performed separately at patient and clinic-visit level. T-tests, chi-square analysis, and multivariate logistic regressions were used where appropriate. The prevalence of having at least one PIM at patient and clinic-visit level was highest with the Beers (82.67%, 36.14% respectively), followed by the PRISCUS (68.49%, 25.13%) and PIM-Taiwan (63.04%, 19.21%) criteria. At patient level, polypharmacy (odds ratio (OR) 2.53 to 4.90), higher number of clinic (OR 1.15 to 1.41), hospital (OR 1.24 to 1.64), and physician (OR 1.15 to 1.41) visits were associated with PIM use for all 3 sets of criteria. At clinic-visit level, internist/family physicians (OR 1.26 to 1.72) and neurologists/psychiatrists (OR 1.73 to 5.87) were more likely to prescribe PIMs than others. Psychotropic drugs and first generation antihistamines accounted for most of the top ten PIMs. The prevalence of PIMs was high among older Taiwanese HHSRs. Polypharmacy and certain medical specialties were associated with a higher likelihood of PIM prescriptions. Provider education and medication review and reconciliation should be considered.