Studies: Underprescribing, overprescribing both common

This problem is particularly difficult for older patients on multiple medications.

By Victoria Stagg Elliott, AMNews staff. Nov. 20, 2006.

Finding the right fit for the prescription drugs taken by patients -- especially those who are older and on multiple medications -- is a difficult balance, according to a pair of studies published in October.

One, appearing in Medical Care, was based on the results of researchers' interviews and reviews of the records of 3,457 adults across the United States. They found that nearly 17% were prescribed a drug they did not need, but more than 37% didn't receive what they should have.

"Overuse and underuse is a problem everywhere," said William Shrank, MD, MSHS, lead author and an instructor at Brigham and Women's Hospital and Harvard Medical School in Boston.

The second paper, this one in the Journal of the American Geriatrics Society, found that 65% of the 196 older patients studied were on a drug they shouldn't have been taking and 64% were missing an important medication from their regimen. Many were both lacking a drug and taking one that was unnecessary.

"It's an issue of quality," said Michael Steinman, MD, lead author on that study and a geriatrician at the San Francisco VA Medical Center. "We need to be attentive to both of these prescribing problems."

Experts say some of these deficiencies, though not all, may be accounted for by individual factors associated with either the patient or doctor. These include variables such as concern about side effects or the preference to be less aggressive with a patient with a shorter life expectancy.