1. Does the Beer’s Criteria Influence Prescribing for Geriatric Patients?
Denise Dong, PharmD Candidate, Rebecca M. Brady, PharmD
INTRODUCTION
RESULTS
Figure 1: Prescriber’s knowledge of the Beer’s Criteria in practice
The Beer’s Criteria was first developed in 1991 by Mark H. Beers with the intent to reduce use of high-risk and potentially inappropriate medications (PMI) among elderly patients.1
The list was updated in March 2012 to include strength and recommendation grading for each PMI. The update incorporated 3 main tables which includes PMI in elderly, PMI and disease state, and PMI to be used with caution in the elderly.2
Table 1: Demographic Information of prescribers
N=21 (%)
Percentage of patients ≥65yo
11-20%
3 (14)
21-30%
2 (10)
31-40%
41-50%
1 (5)
51-60%
8 (38)
≥61%
5 (24)
Practice setting
Hospital
Ambulatory
10 (48)
Other
Practice specialty
Emergency medicine
Family medicine
Internal medicine (General)
Internal medicine (Geriatric)
4 (19)
Mean years of practice
12 yrs ±9.27
Risk Factors for Adverse Drug Event in Elderly Patient3
Multiple medication use increase potential for drug interaction and adverse drug event.
Age-related pharmacokinetic changes can alter drug absorption, distribution, metabolism, and excretion.
Age-related pharmacodynamic changes affect how the drugs effects the body.
Multiple providers increase risk of duplication therapy and drug error.
Figure 2:
Average scale of prescribers’ familiarity with the Beer’s Criteria (1 indicates complete disagreement and 10 indicates total agreement)
How often prescribers mention using Beer’s Criteria as a resource for the case-scenario questions
Table 2:
Practice Specialty (N)
Mention Beer’s Criteria (%)
Emergency medicine (2)
1 (5)
Family medicine (8)
3 (14)
Internal medicine (2)
Internal medicine: Geriatric (5)
Other (4)
METHODS
Inclusion: Licensed medical residents, physicians, and medical personnel with prescribing authority and are actively practicing.
Exclusion: Medical residents and prescribing clinicians whose geriatric patient population is composed of less than 10% of their practice and medical students.
Design: Survey was established and distributed using UNC Odum Qualtrics program. Survey questions were categorized into demographic, case-scenario, and Criteria-use questions.
Methods: The link to the survey was distributed to prescribers in the North Carolina Medical Society. In the case-scenario questions, prescribers are given a case and ask to provide resources/literature that was used to answer the question. In the criteria-use questions, prescribers were asked about their familiarity with the Beer’s Criteria. Responses were collected from Dec 15, 2012-Feb 15, Descriptive statistics was used to analyze result and Fisher Exact test was used to assess for statistical significance in secondary endpoint.
Primary Endpoint: Evaluate prescriber’s use of the Beer’s Criteria when responding to case scenario questions and assess prescriber’s familiarity with the criteria in the clinical setting.
Secondary Endpoint: Determine if response differs depending on prescriber’s specialty and practice setting.
Fisher Exact test show no statistical significance (p=0.87)
Practice Setting (N)
Mention Beer’s Criteria (%)
Hospital (8)
3 (14)
Ambulatory (10)
4 (19)
Other (3)
Fisher Exact test show no statistical significance (p=0.6)
CONCLUSIONS
A total of 7 out of 21 prescribers (33%) refer to the use of Beer’s Criteria or the use of a database that references the Beer’s Criteria (e.g. Lexi-comp, Epocrates, and Up-to-Date) to answer the four case-scenario questions.
The mention of Beer’s Criteria was not statistically significant between different practice specialty (p=0.87) and between different practice setting (p=0.6).
Even though 67% of prescribers know they have access to the Beer’s Criteria in their practice setting, the majority of prescribers indicated not using the criteria when prescribing medication with the average use scale score of 3.33/10. When assessing coworkers use of the criteria the average scale score was even lower at 2.95/10.
Prescribers response to the free text question about changes/additions they would like to see in the Beer’s Criteria include:
Incorporate information and safer alternative medication options, make an iphone app, add the new anticoagulant and antiarrhythmic agents into the Criteria, and make the chart easier to read.
REFERENCES
Hanlon JT, Schmader KE, Kornkowski MJ, et al. Adverse drug events in high risk older outpatients. J Am Geriatr Soc. 1997;45:
The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. AGS Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2012; 38(6):3-5.
Mangoni AA and Jackson SHD. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2004; 57:6–14.