When you prescribe a new medication to adults ages 65 and older, please keep
in mind that certain medications have a greater potential for side effects.
Patients in this age group are twice as likely as those younger than 65 to
experience adverse drug events — and almost seven times as likely to be
hospitalized from them.
Keep in mind the following when potentially prescribing these
medications:
- High-risk medications. The National Committee for Quality
Assurance (NCQA) developed the High Risk Medication (HRM) list through its
HEDIS®* program. The Pharmacy Quality Alliance (PQA) has adapted
and endorsed NCQA?s HRM measure. Working alongside the Centers for Medicare &
Medicaid Services (CMS) to improve the quality of health care, PQA maintains a
list of medications considered to be high-risk in older adults. This list is
based on the ?Beer?s Criteria? from the American Geriatrics Society standard
list for potentially inappropriate medication use in older adults. CMS measures
the number of Medicare Advantage HMO members ages 65 and older who are
receiving HRMs from the list. Using this information, CMS grades each health
plan?s quality of care through its Stars† program.
- Adverse drug events. Through the Beer?s Criteria, HRMs
have been proven to put older patients at a higher risk for adverse drug
events. For example, medications such as zolpidem, amitriptyline, estrogens,
and glyburide place patients at a higher risk for drug-related toxicities and
increased risk for falls and fractures. Looking at the criteria, we have an
opportunity to minimize the use of these and other medications deemed
high-risk.
There is an even greater risk when a patient is on more than one medication
considered an HRM. Careful and appropriate use of drugs in the senior
population is a critical quality-of-care issue. For these reasons we suggest
that you use caution when prescribing one or more drugs on the list to patients
ages 65 and older.
View the complete list of HRMs here. Look for more
information about HRMs in the January 2016 edition of Partners in Health
UpdateSM.
*The Healthcare Effectiveness Data and Information Set
(HEDIS) is an NCQA tool used by more than 90 percent of U.S. health plans to
measure performance on important dimensions of care.
†Stars is a program developed by CMS to
measure quality health care. Ratings are published annually to help educate
consumers prior to enrollment decisions.