New thesis: EVERY COIN HAS TWO SIDES The challenge of addressing inappropriate prescribing in older patients in primary care

Hi Katharina Schmidt-Mende, PhD-student at the Division of Family Medicine and Primary Care. On 25 April you will defend your thesis "EVERY COIN HAS TWO SIDES - The challenge of addressing inappropriate prescribing in older patients in primary care", what's the main focus of the thesis?

Patients aged 65 and older with many diseases who are prescribed multiple drugs are mainly treated in primary care. The more drugs a patient is treated with, the higher is the risk for severe side effects. As general practitioner, I experience every day how challenging it is to improve older patients' drug use.

My thesis is about how older patients in primary care are treated with inappropriate drugs and dosages in relation to their renal function, and how commonly they use drugs that may worsen a comorbidity (such as certain pain killers that may deteriorate heart failure). We also wanted to understand more about general practitioners´ and nurses´ views on inappropriate prescribing. Therefore we evaluated if educational sessions on medication reviews provided primary care practices may improve the quality of prescribing.

Which are the most important results?

We demonstrated that one third of older patients with impaired renal function visiting primary care practices are prescribed either too high drug dosages or contraindicated drugs. Moreover, every tenth older patient was treated with a drug that may worsen a comorbidity. Interestingly, only a few drugs accounted for the majority of inappropriate prescribing, such as non-steroidal anti-inflammatory drugs. We did not find that our applied educational intervention on how to perform medication reviews improved prescribing. A possible explanation for these negative results is the complexity of medical care and drug treatment in older patients. Both general practitioners and nurses expressed that this complexity is a major challenge. They feel that their efforts to achieve appropriate prescribing are undermined by this complexity.

How can this new knowledge contribute to the improvement of people's health?

My research identifies important areas of inappropriate prescribing in older patients. My findings may help general practitioners and nurses in primary care to prevent side effects of drug treatment and thus unplanned hospital admissions or emergency department visits in older patients.

What's in the future for you? Will you keep on conducting research?

I will continue to combine clinical work with older patients and research . To date, this frail patient group has not received enough attention. I want to know more about older patients´ views on their drug treatment. I would also love to contribute to the development and implementation of treatment guidelines on multimorbidity since medical care of these patients is one of the major challenges we face in primary care.