Dr. Deborah Kelly

By Sharon Gray
A collaborative study between Memorial’s School of Pharmacy and the Newfoundland and Labrador Centre for Health Information (NLCHI) benchmarks medication use across the province and estimates the extent of inappropriate medication use among seniors.

Dr. Deborah Kelly, Pharmacy, was principal investigator for the study. The NLCHI has a mandate to develop a provincial Health Information Network that will be the building block for the electronic health record. “There’s never been a benchmark of prescription use in the province,” explained Dr. Kelly. “Now that we have this base information, future studies can be compared to it. It will be possible to assess whether the Health Information Network makes a difference in terms of the impact on the type and appropriateness of medications being used in the province.”

The primary objective of the study, Profiling Prescription Medication Utilization in Newfoundland and Labrador: Optimizing the Quality of Drug Therapy, was to look at medication use both globally and by region, for five of the seven health board regions. The study also looked at prescription use among seniors.

“We were able to gather quite a lot of data on medication usage among those over 65 because of the seniors’ drug card that goes with the Newfoundland and Labrador prescription drug plan,” said Dr. Kelly. “We were particularly interested in seniors because they use such a high proportion of health care resources and they are at a high risk of running into problems with medication because they often have multiple diseases, and physiologically they are more susceptible to adverse effects of medication.”

While not able to gather information on outcomes – for example, the number of times the use of an inappropriate medication results in an emergency room visit by a senior – Dr. Kelly said literature studies have identified medications that should not be used in older people based on the likelihood that they may cause adverse effects. Reports in the literature suggest that about 12 per cent of hospital admissions and 15 to 22 per cent of emergency room visits in the elderly are medication-related.

“We found that there were about 23 per cent of seniors under the Newfoundland and Labrador prescription drug plan who received at least one inappropriate medication over a 12-month period. That was in contrast to about 16 per cent of seniors not on the drug plan receiving at least one inappropriate mediation over a 12-month period.”

Dr. Kelly said that these numbers are on par with numbers reported in the literature from U.S. studies. But she cautions that there are many limitations in looking at these percentages. “Just because someone is on a medication that is on this inappropriate list, it doesn’t mean that individual is going to have problems. As well, we don’t know that person’s medical history – maybe they’ve been tried on other medications that would be considered appropriate and they didn’t respond to them or they had adverse reactions.”

Dr. Kelly said the study indicates that there might be an opportunity to improve drug utilization among seniors. “Because this is an estimate it would be really useful to have a more concrete idea of what the current situation is. When the Health Information Network is in place it will allow us to link prescription utilization to diagnosis information and outcomes – then we’ll have a clearer understanding of medication appropriateness.”

Pharmacists have an important role to play in improving the situation, said Dr. Kelly. “The pharmacist can talk to the patient about whether the medication is working and determine if he is experiencing any adverse effects. When a problem is identified, then the pharmacist should pick up the phone, call the physician, and have a conversation about this. It’s a matter of building partnerships.”

Profiling Prescription Medication Utilization in Newfoundland and Labrador: Optimizing the Quality of Drug Therapy will be distributed to stakeholders in the province and is available to the public at the Web site www.nlchi.nf.ca/.

Co-investigators of this study were Dr. Doreen Neville, Community Health, Melanie Healey, Newfoundland Pharmaceutical Association, Don MacDonald, NLCHI, Colleen Janes, Department of Health and Community Services, and Margot Priddle, NLCHI.