National indicators for quality of drug therapy in older persons: the Swedish experience from the first 10 years

Abstract

Inappropriate drug use is an important health problem in elderly persons. Beginning with the Beers' criteria in the early 1990s, explicit criteria have been extensively used to measure and improve quality of drug use in older people. This article describes the Swedish indicators for quality of drug therapy in the elderly, introduced in 2004 and updated in 2010. These indicators were designed to be applied to people aged 75 years and over, regardless of residence and other characteristics. The indicators are divided into drug specific, covering choice, indication and dosage of drugs, polypharmacy, drug-drug interactions (DDIs), drug use in decreased renal function and in some symptoms; and diagnosis specific, covering the rational, irrational and hazardous drug use in common disorders in elderly people. During the 10 years since introduction, the Swedish indicators have several applications. They form the basis for recommendations for drug therapy in older people, are implemented in prescribing supports and drug utilisation reviews, are used in national benchmarking of the quality of Swedish healthcare and have contributed to initiatives from pensioner organisations. The indicators have also been used in several pharmacoepidemiological studies. Since 2005, there have been signs of improvement of the quality of drug prescribing to elderly persons in Sweden. For example, the prescribing of drugs that should be avoided in older persons decreased by 36 % between 2006 and 2012 in persons aged 80 years and older. Similarly, drug combinations that may cause DDIs decreased by 26 % and antipsychotics by 41 %. The indicators have likely contributed to this.

Fig. 1

The structure of a drug-specific indicator from the Swedish indicators for quality of drug therapy in the elderly, exemplified by indicator 1.1 ‘Drugs that should be avoided unless specific reasons exist’, consisting of four items. ATC codes for the included drugs are presented within brackets. ATC Anatomical Therapeutic Chemical

Fig. 2

The structure of a diagnosis-specific indicator from the Swedish indicators for quality of drug therapy in the elderly, exemplified by indicator 2.2 ‘Ischemic heart disease–angina pectoris’. The indicator consists of six items, the first two about rational drug use and the remaining four about irrational or hazardous drug use. ASA acetylsalicylic acid