Elderly patients in community outpatient clinics often suffer from multiple chronic conditions and were particularly vulnerable to potentially inappropriate prescribing (PIP) .

To analyze the influencing factors of prescriptions for elderly patients becoming PIP in community outpatient clinics.

In March 2021, a combination of cluster sampling and simple random sampling was used to select drug prescriptions from elderly patients who visited a community health service center in Beijing from January 1 to December 31, 2019. The prescriptions were evaluated by two pharmacists with intermediate titles based on 2019 American Geriatrics Society Beers Criteria (abbreviated as Beers criteria) and Criteria of Potentially Inappropriate Medications for Older Adults in China (abbreviated as China criteria) , respectively. At the same time, the researchers collected the relevant data of the prescriber, elderly patients and the content of the prescription, and compared the differences in the characteristics of the prescriber, the prescription object and the prescription content of the prescriptions with different evaluation results. Binary Logistic regression method was used to analyze the factors affecting PIP prescribing and to conduct sensitivity analysis (selected prescriptions for patients≥65 years of age) . Descriptive analysis was used to describe the distribution of inappropriate medicine in PIP.

A total of 815 outpatient prescriptions for elderly patients were included, including 266 (32.6%) PIP under the Beers criteria or 182 (22.3%) PIP under the Chinese criteria, respectively. According to the Beers criteria, the differences were statistically significant when comparing the age of prescribers, the age of elderly patients, the proportion of those with the diagnosis of hypertension and insomnia, the number of drug varieties, and the proportion of those with the drug categories of cardiovascular system drugs, antithrombotic drugs, central nervous system drugs, and gastrointestinal system drugs between PIP and non-PIP (P<0.05) . According to the China criteria, the differences were statistically significant when comparing the age or title distribution of prescribers, the proportion of those with the diagnosis of hypertension, coronary heart disease, diabetes, insomnia and osteoarthritis, and the proportion of those with the drug categories of cardiovascular system drugs, antithrombotic drugs, non-insulin hypoglycemic drugs, central nervous system drugs and non-steroidal anti-inflammatory drugs (NSAIDs) between PIP and non-PIP (P<0.05) . The binary Logistic regression results showed that, no matter under the Beers criterion or the Chinese criterion: the prevalence of coronary heart disease or insomnia in elderly patients had an impact on the prescription of PIP, and the inclusion of antithrombotic agents in the prescription was an influencing factor affecting the formation of PIP (P<0.05) . The results of the sensitivity analysis showed that hypertension, coronary heart disease and insomnia in elderly patients have an impact on the prescribing of PIP; the inclusion of antithrombotic medication in the prescription was an influencing factor affecting the formation of PIP (P<0.05) . According to the Beers' criterion, 266 PIP involved a total of 302 cases of inappropriate drug use, of which antithrombotic drugs accounted for 46.4% (140/302) , central nervous system drugs accounted for 16.2% (49/302) , endocrine system diabetes (non-insulin) drugs accounted for 13.9% (42/302) . According to the Chinese criterion, 182 PIP involved inappropriate medications in a total of 205 cases, of which antithrombotic drugs accounted for 44.9% (92/205) , central nervous system drugs accounted for 25.9% (53/205) , oral NSAIDs accounted for 14.1% (29/205) .

Among the community outpatient prescriptions for elderly patients, PIP accounted for a relatively high proportion. In the future, emphasis should be placed on community physicians' knowledge of safe and rational drug use, the use of antithrombotic drugs should be standardized, and the review of drug prescriptions for patients with hypertension, coronary artery disease and insomnia should be strengthened.