Prevalence and Predictors of Potentially Inappropriate Prescribing in Middle-Aged Adults: Repeated Cross-Sectional Study

Abstract

Background: Potentially inappropriate prescribing (PIP) is common in older adults and known to be associated with polypharmacy and multimorbidity. Less is known about the prevalence and causes of PIP in middle-aged adults. Aim: To determine the prevalence and predictors of PIP in middle-aged adults. Design and Setting: A repeated cross-sectional study was conducted using primary care data in London. Method: PIP was defined using the PRescribing Optimally in Middle-aged People’s Treatment (PROMPT) criteria. Prescribing and demographic data were extracted from Lambeth DataNet (LDN), a pseudonymised database of all patients registered at general practices in Lambeth, for those aged 45-64 years prescribed ≥1 medicines in each year, 2014-2019 (n=46,633-52,582). Prevalence and trends over six years were investigated, including the association of PIP with polypharmacy, multimorbidity, deprivation, gender and age. Results: The prevalence of PIP decreased from 20% in 2014 to 18% in 2019. The most prevalent PROMPT criteria in 2019 were the use of ≥2 drugs from the same pharmacological class (7.6%), use of NSAIDs for >3 months (7%) and use of PPIs above recommended maintenance dosages for >8 weeks (3%). Over the study period, the prevalence of multimorbidity increased (47-52%), and polypharmacy remained stable (27%). Polypharmacy, multimorbidity, deprivation and age were independently associated with PIP. Conclusions: Almost a fifth of middle-aged adults prescribed medicines are exposed to PIP, as defined by the PROMPT criteria. This is likely to be linked with exposure to avoidable adverse drug events. The PROMPT criteria may provide a useful aid in interventions to optimise prescribing.