engleski

Secondary use of routinely collected health data and caring for the elderly: a case study of potentially harmful prescribing

Introduction and objectives. Elderly are the largest group of users of prescription medications. Over 20 % of the population in Croatia is older than 65 years and this proportion is expected to increase as the population is ageing. Due to the multi-morbidities, multiple concomitant medicines, and underlying metabolic and cognitive changes, drug prescribing in the elderly can result in adverse health outcomes and unnecessary costs for the health system. The objective of our work is to explore the potential of secondary use of routinely collected health data for generating the evidence in support of healthy ageing, using potentially inappropriate drug prescribing as a case study. Methods. The Central Health Information System of the Republic of Croatia (CEZIH) is the largest source of routinely collected health data in Croatia. Based on the published functional specification, we analysed CEZIH in terms of its structure and available data elements. As a measure of inappropriate drug prescribing, we chose the internationally accepted STOPP/START criteria (Screening Tool of Older People’s Prescriptions and Screening Tool to Alert to Right Treatment) for prescribing in older people. We compared the data contained in CEZIH with the information needed for the implementation of the STOPP/START criteria. Results. The STOPP/START criteria provide 114 evidence based rules to avoid commonly encountered points of potentially inappropriate prescribing. The precondition to apply those rules is availability of information on patient age, prescribed medications, indications, medical conditions. ePrescription contains structured information for over 99% of medicines prescribed/ dispensed in the primary care setting since 2011. The attributes available in ePrescription include brand name, active substance, dose, form, indication, date of prescription and dispensation, patient identifier which allows for application of 38 STOPP/START criteria. Additional information can be retrieved from the electronic healthcare record within CEZIH (64 criteria). Conclusion. Routinely collected electronic patient data in Croatia can be used to generate the evidence on inappropriate drug prescribing using STOPP/ START criteria. Such analyses have been done in many countries to assess suboptimal prescribing practices, however, in Croatia, this has not been the case despite the importance of the issue. Secondary use is a complex process that requires accessible data, understanding of data sources, data structure and research methodologies. Interdisciplinary and inter-institutional collaboration is important to make the most of the results and to support regulatory actions and policy development.

secondary health data ; CEZIH ; harmful prescribing

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