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In the News

From the July ACP Hospitalist, copyright © 2008 by the American College of Physicians

Report: Many elderly take inappropriate prescription drugs

A substantial number of Americans age 65 and older say they use at least one prescription drug that is inappropriate for their age, the Agency for Healthcare Research and Quality reported recently.

About a quarter of older Americans with disabilities, and 13% of elderly people without disabilities, use inappropriate drugs, according to an analysis of 2004 data. Thirty-three drugs are deemed inappropriate for people 65 and older because they carry a high risk of side effects, are ineffective, or a safer alternative is available. Examples include alprazolam (Xanax), propoxyphene (Darvon) and meperidine (Demerol).

The analysis also found that use of the drugs was more common among older adults with complex disabilities (27%) than basic disabilities (23%), and that those with a high school education or less were more likely to use inappropriate drugs than those who went to college. The analysis is based on data in the AHRQ’s National Healthcare Disparities Report, which shows disparities in health care access and quality according to race, ethnicity, income and education.

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Use of PAMV could more than double by 2020

The number of patients requiring prolonged acute mechanical ventilation (PAMV) is expected to more than double by 2020, a recent study has reported.

PAMV is resource intensive and does not usually yield better survival rates than shorter-term use. Researchers used 2000–2005 data from the Agency for Healthcare Research and Quality’s National Inpatient Sample/Health Care Utilization Project and the U.S. Census Bureau to calculate historic annual age-adjusted rates of PAMV use and to project future growth by age group. The study was published in the May Critical Care Medicine.

According to the authors’ estimates, PAMV increased by 5.5% per year compared with 1.1% per year for the U.S. population and hospital admissions. Annualized growth was 7.9% in patients age 44 to 65 years, 4.7% in patients age 18 to 44 years, 4.6% in patients age 85 years and older and 3.4% in patients age 65 to 84 years. The authors projected that annual use of PAMV will increase from approximately 250,000 cases in 2000 to 605,898 cases in 2020.

The authors concluded that the observed increased rates of PAMV will affect future hospital resource allocation, especially in intensive care units. Although their study had several limitations, including lack of information on location of patients’ hospital stays and use of historical data, their findings point to an increased need for critical care services over the next decade. Future studies, they said, should examine more efficient care strategies and long-term outcomes to help facilitate decisions about end-of-life care.

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Safety net hospitals try rerouting nonurgent care

Emergency departments at safety net hospitals are looking for ways to redirect patients who don’t need urgent treatment, according to a recent report from the Center for Studying Health System Change (HSC).

The HSC conducts site visits every two years in 12 nationally representative metropolitan areas. In 2007, it found that busy EDs at safety net hospitals are attempting to solve overcrowding for nonurgent care by helping patients establish “medical homes,” increasing referrals to clinics, assisting patients in scheduling appointments, and collaborating with health centers, among other methods.

The report concluded that ED overcrowding due to nonurgent care could be mediated by a combination of these solutions. In addition, the authors recommended coordinating hours of operation among providers and services; providing transportation in low-income areas; improving communication and coordination among community providers and ED staff; and increasing patients’ knowledge about alternative sources of low-cost care.

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Hospitalization rates for ischemic stroke decrease over eight years

Hospitalizations for ischemic stroke decreased by one-third between 1997 and 2005, while rates for hemorrhagic stroke remained steady, the Agency for Healthcare Research and Quality (AHRQ) recently reported.

Approximately 36 per 10,000 Americans age 45 years and older were hospitalized for ischemic stroke in 2005, compared with approximately 54 per 10,000 persons in 1997. Hospitalizations for hemorrhagic stroke in this age group, however, did not change substantially during the same time period (range, nine to 11 per 10,000 persons). The findings were part of a statistical brief released by AHRQ’s Healthcare Cost and Utilization Project, which analyzed data from the Nationwide Inpatient Sample.

Other 2005 findings from the report included the following:

• Hospitalizations for stroke numbered 892,300 and accounted for $8.5 billion in hospital costs.
• 25.1% of hemorrhagic stroke patients died in the hospital versus 5.9% of patients with ischemic stroke.
• The likelihood of transfer to rehab or nursing homes differed by condition (ischemic stroke, 44%; hemorrhagic stroke, 36.9%; transient cerebral ischemia, 13.2%; and occlusion/stenosis of precerebral arteries, 4.8%).
• One in 10 people admitted for hemorrhagic stroke was younger than 45 years of age.

In the News is a product of ACP HospitalistWeekly, an e-newsletter provided every Wednesday by ACP Hospitalist. If you're not already receiving ACP HospitalistWeekly, contact Customer Service at 800-523-1546, ext. 2600, or direct at 215-351-2600 (M-F, 9 a.m. to 5 p.m. EST) or send an e-mail to custserv@acponline.org.

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ACP Hospitalist provides news and information for internists about the practice of medicine and reports on the policies, products and activities of ACP. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated