About the Metric
Definition
The average number of concurrent medications prescribed per older patient.
Background
The total number of medication prescriptions in the US has increased by 85% over the last two decades. In particular, prescription drug use in patients aged 65 years or older has increased dramatically. Older patients are at a particularly high risk for drug-related injuries such as falls and medication interactions. Polypharmacy (a patient being on too many medications) has been associated with increased medical cost, increased hospitalizations, and increased mortality. Primary care clinicians are in a unique position to lead deprescribing efforts when patients they see are on too many medications.
How It Works
Numerator
The total number of concurrent medications summed across the patients from the denominator. For each patient, the number of concurrent medications is defined as the maximum number of concurrent medications in use on any day during the study period. The fill date and days of supply should be used to calculate the days of medication use. Overlapping days of the same medication should be credited by shifting the start date of the subsequent prescription to the day after the previous prescription was completed. Medications of the same generic name and different dosage strength should be considered the same medication. Only prescription medications with at least 30 days of supply should be included.
Denominator
The number of patients aged 65 years or older who filled any prescription by a given primary care physician during the study period.
Inclusion Criteria
All patients aged 65 years or older seen by a primary care clinician who filled any prescription during the study period, regardless of the prescriber.
A primary care physician is defined using specialty taxonomy to include family medicine and internal medicine. Taxonomy codes: Family Medicine 207Q00000X, General Practice 208D00000X, Internal Medicine 207R00000X.
Exclusion Criteria
Patients who have undergone organ transplantation, chemotherapy, or have a diagnosis of HIV:
- All chemotherapy codes = J9000-J9999
- Status post organ removal [transplantation] = Z98.85
- Status awaiting organ transplant = Z76.82
- Transplant organ and tissue status = Z94.0 – Z94.9
- Encounter for administration of chemotherapy = Z51.11
- Personal history of antineoplastic chemotherapy = Z92.21
- HIV positive with complications = ICD-10-CM: B20
- HIV asymptomatic = Z21
Attribution
The primary care physician
GAM Thresholds™
GAM establishes clinical thresholds using the input of key physician leaders within a specialty and the GAM clinical team. GAM utilizes an elaborate consensus building process with final adjudication by our leadership team.
| Cases | Pattern of Concern | Outlier |
|---|---|---|
|
11+ |
6 - 7.7 |
>7.7 |
