Background: Inappropriate medication use is a major healthcare issue for the elderly population. This study explored the prevalence of potentially inappropriate prescriptions (PIPs) in long-term care in metropolitan Quebec. Methods: A cross sectional chart review of 2,633 long-term care older patients of the Quebec City area was performed. An explicit criteria list for PIPs was developed based on the literature and validated by a modified Delphi method. Medication orders were reviewed to describe prescribing patterns and to determine the prevalence of PIPs. A multivariate analysis was performed to identify predictors of PIPs. Results: Almost all residents (94.0%) were receiving one or more prescribed medication; on average patients had 4.8 prescribed medications. A majority (54.7%) of treated patients had a potentially inappropriate prescription (PIP). Most common PIPs were drug interactions (33.9% of treated patients), followed by potentially inappropriate duration (23.6%), potentially inappropriate medication (14.7%) and potentially inappropriate dosage (9.6%). PIPs were most frequent for medications of the central nervous system (10.8% of prescribed medication). The likelihood of PIP increased significantly as the number of drugs prescribed increased (odds ratio [OR]: 1.38, 95% confidence interval [CI]: 1.33 – 1.43) and with the length of stay (OR: 1.78, CI: 1.43 – 2.20). On the other hand, the risk of receiving a PIP decreased with age. Conclusion: Potentially inappropriate prescribing is a serious problem in the highly medicated long-term care population in metropolitan Quebec. Use of explicit criteria lists may help identify the most critical issues and prioritize interventions to improve quality of care and patient safety.

Lack of adherence to drug treatment is a major obstacle to disease control. Although many studies have examined adherence to antipsychotic treatment, they have generally suffered from lack of differentiation between persistence and compliance as 2 separate components of adherence. In an outpatient population, to (1) measure the proportion of atypical antipsychotic users who were still on antipsychotic treatment after 12 months, (2) measure the proportion of compliant users among them, and (3) identify the determinants of persistence and of compliance. We carried out a population-based cohort study using the Quebec Health Insurance Board database. Patients previously diagnosed with schizophrenia (ICD-9 criteria) and initiated on clozapine, olanzapine, quetiapine, or risperidone treatment between January 1, 1997, and August 31, 1999, were included. Patients still undergoing treatment with any atypical antipsychotic drug 1 year after their first prescription were considered persistent. Of these patients, those with a supply of drugs for at least 80% of the days were deemed compliant. To identify the characteristics associated with both outcomes, we built a multivariate logistic regression model using a stepwise procedure and calculated odds ratios and their 95% confidence interval. Of 6662 individuals initiated on treatment with atypical antipsychotics, 4495 (67.5%) were still on the treatment after 1 year, and 3534 (78.6% of those who persisted) were compliant. Patients more likely to be both persistent and compliant were those initiated on clozapine, those who received a treatment of medium or high intensity, those who had used atypical antipsychotics, those without a history of substance-use disorder, and those on welfare. On the other hand, patients who were prescribed their first atypical antipsychotic by a psychiatrist were more likely to be persistent, whereas those with a high comorbidity index and those aged 35 years or more were more likely to be compliant. One year after treatment initiation, almost a third of patients were no longer treated with atypical antipsychotics. Of those still being treated, more than 20% were noncompliant. Further studies should focus on means of improving such erratic treatment behaviors.

Background: The link between experiencing difficulties in reading or understanding and non-compliance with drug treatment among seniors is not clearly established. Objectives: We measured the effect of both difficulties in reading, as well as difficulties in understanding prescription labelling, on non-compliance with drug treatments among seniors. Since the use of a pill organizer prepared by a pharmacist may compensate for the problems in reading, we also checked the potential modifying effect of the use of a pill organizer on these two associations. Method: Data on non-compliance with drug treatment, comprehension of prescription labelling and on the factors potentially linked to non-compliance, were collected during face-to-face interviews with 325 seniors. Results: In all, 126 respondents (38.8%) were not able to read all the prescription labels and 218 (67.1%) did not fully understand all the information. 153 respondents were non-compliant with their drug treatment. After adjusting for sex, age, living alone or not, having had help with taking the medication, use of a pill organizer, having had sufficient funds to procure his medicine during the previous month, belief in the efficacy of his medication, perception of his state of health, satisfaction with physician-given and pharmacist-given information, as well as the complexity of the treatment, the two associations remained statistically non-significant. The use of a pill organizer was not a modifying factor. Conclusion: Our results did not demonstrate the existence, among seniors, of an association between non-compliance and difficulty in reading and understanding prescription labelling.