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Table 1 Quality indicators (QIs) for optimal prescription patterns for elderly ≥ 70 years

From: A cluster-randomized educational intervention to reduce inappropriate prescription patterns for elderly patients in general practice – The Prescription Peer Academic Detailing (Rx-PAD) study [NCT00281450]

  Quality Indicator Aim Concern
1. Use of an explicit list of regular medications when prescribing from the GP's electronic medical record. The share (% of GPs using an explicit list of regular medication as default list) should be as high as possible. Suggests that GPs have a more complete view of their patients' total regular medications.
2. Tricyclic antidepressants:
• Amitryptiline
• Doxepin
• Trimipramine
The share (% of individuals ≥70 years) should be as low as possible. Strong anticholinergic and sedative properties increase the risk for impaired cognitive functioning in the elderly.
Increased risk for urinary retention (males), constipation, impaired vision, and falls and fractures.
3. 1st. generation antihistamines:
• Dexchlorpheniramine
• Promethazine
• Alimemazine
• Hydroxycin
The share (% of individuals ≥ 70 years) should be as low as possible. Strong anticholininergic properties. Should be avoided in the elderly.
Especially Promethazine and Alimemazine may cause extrapyramidal ADEs.
4. 1st. generation (low-potency) antipsychotics:
• Chlorpromazine
• Chlorprotixene
• Levoprometazine
• Prochlorperazine
The share (% of individuals ≥ 70 years) should be as low as possible. Strong anticholinergic and sedative properties. May cause extrapyramidal and orthostatic ADEs.
Prochlorperazine has no documented effect on gait problems in the elderly.
5. Long acting benzodiazepines:
• Nitrazepam
• Flunitrazepam
The share (% of individuals ≥ 70 years) should be as low as possible. Long half-life and risk of accumulation may produce prolonged sedation, and cause falls and fractures.
6. The muscle relaxant Carisoprodol. The share (% of individuals ≥ 70 years) should be as low as possible Poorly tolerated in elderly patients.
Anticholinergic properties. Sedative and relaxing properties, with increased risk of falls and fractures.
7. Strong analgesics poorly tolerated by the elderly:
• Propoxyphene
• Pethidine
• Opioids with spasmolytics
The share (% of individuals ≥ 70 years) should be as low as possible. Propoxyphene is poorly tolerated by the elderly.
Pethidine may cause convulsions and renal failure.
Ketobemidone/diphelyldimetylaminobutene has anticholinergic properties.
8. Long term oral use of Theofylline The share (% of individuals ≥ 70 years) should be as low as possible. Narrow therapeutic index. Poorly documented effect on Chronic Obstructive Pulmonary Disease (COPD).
9. Combination of a systemic beta blocking agent with an unselective calcium channel blocker:
• Verapamil, or:
• Diltiazem
The share (% of individuals ≥ 70 years) should be as low as possible. A nonselective calcium channel blocker in combination with a beta blocking agent may cause myocardial depression and atrioventricular heart block.
10. Combination of NSAID (non-steroid anti-inflammatory drug) and Warfarin. The share (% of individuals ≥ 70 years) should be as low as possible. Increased risk for gastrointestinal bleedings with or without elevated INR-levels.
11. Combination of NSAID (or a Cox2-inhibitor) and ACE-inhibitor (or an A2-blocker). The share (% of individuals ≥ 70 years) should be as low as possible. May cause kidney failure in elderly patients, particularly if presence of general arteriosclerosis, dehydration or concurrent use of diuretics.
12. Combination of NSAID and SSRI (selective serotonin reuptake inhibitors). The share (% of individuals ≥ 70 years) should be as low as possible. The combination of NSAID and SSRI increases the risk of gastrointestinal bleeding.
13. Combination of NSAID and diuretics. The share (% of individuals ≥ 70 years) should be as low as possible. May reduce the effect of diuretics and worsen existing heart failure.
14. 3 or more psychotropic drugs:
• N02A* Analgesics containing opioids
• N05* Psycholeptics:
1. antipsychotics
2. hypnotics
3. tranquillizers
• N06A* Antidepressants
The share (% of individuals ≥ 70 years) receiving three or more different psychotropic drugs should be as low as possible. Increased risk for excessive sedation, interactions and central nervous adverse effects.
Increased risk for falls and fractures.
  1. * Anatomical Therapeutic Chemical (ATC) classification code.