Quality Indicator | Aim | Concern | |
---|---|---|---|
1. | Use of an explicit list of regular medications when prescribing from the GP's electronic medical record. | The share (% of GPs using an explicit list of regular medication as default list) should be as high as possible. | Suggests that GPs have a more complete view of their patients' total regular medications. |
2. | Tricyclic antidepressants: • Amitryptiline • Doxepin • Trimipramine | The share (% of individuals ≥70 years) should be as low as possible. | Strong anticholinergic and sedative properties increase the risk for impaired cognitive functioning in the elderly. Increased risk for urinary retention (males), constipation, impaired vision, and falls and fractures. |
3. | 1st. generation antihistamines: • Dexchlorpheniramine • Promethazine • Alimemazine • Hydroxycin | The share (% of individuals ≥ 70 years) should be as low as possible. | Strong anticholininergic properties. Should be avoided in the elderly. Especially Promethazine and Alimemazine may cause extrapyramidal ADEs. |
4. | 1st. generation (low-potency) antipsychotics: • Chlorpromazine • Chlorprotixene • Levoprometazine • Prochlorperazine | The share (% of individuals ≥ 70 years) should be as low as possible. | Strong anticholinergic and sedative properties. May cause extrapyramidal and orthostatic ADEs. Prochlorperazine has no documented effect on gait problems in the elderly. |
5. | Long acting benzodiazepines: • Nitrazepam • Flunitrazepam | The share (% of individuals ≥ 70 years) should be as low as possible. | Long half-life and risk of accumulation may produce prolonged sedation, and cause falls and fractures. |
6. | The muscle relaxant Carisoprodol. | The share (% of individuals ≥ 70 years) should be as low as possible | Poorly tolerated in elderly patients. Anticholinergic properties. Sedative and relaxing properties, with increased risk of falls and fractures. |
7. | Strong analgesics poorly tolerated by the elderly: • Propoxyphene • Pethidine • Opioids with spasmolytics | The share (% of individuals ≥ 70 years) should be as low as possible. | Propoxyphene is poorly tolerated by the elderly. Pethidine may cause convulsions and renal failure. Ketobemidone/diphelyldimetylaminobutene has anticholinergic properties. |
8. | Long term oral use of Theofylline | The share (% of individuals ≥ 70 years) should be as low as possible. | Narrow therapeutic index. Poorly documented effect on Chronic Obstructive Pulmonary Disease (COPD). |
9. | Combination of a systemic beta blocking agent with an unselective calcium channel blocker: • Verapamil, or: • Diltiazem | The share (% of individuals ≥ 70 years) should be as low as possible. | A nonselective calcium channel blocker in combination with a beta blocking agent may cause myocardial depression and atrioventricular heart block. |
10. | Combination of NSAID (non-steroid anti-inflammatory drug) and Warfarin. | The share (% of individuals ≥ 70 years) should be as low as possible. | Increased risk for gastrointestinal bleedings with or without elevated INR-levels. |
11. | Combination of NSAID (or a Cox2-inhibitor) and ACE-inhibitor (or an A2-blocker). | The share (% of individuals ≥ 70 years) should be as low as possible. | May cause kidney failure in elderly patients, particularly if presence of general arteriosclerosis, dehydration or concurrent use of diuretics. |
12. | Combination of NSAID and SSRI (selective serotonin reuptake inhibitors). | The share (% of individuals ≥ 70 years) should be as low as possible. | The combination of NSAID and SSRI increases the risk of gastrointestinal bleeding. |
13. | Combination of NSAID and diuretics. | The share (% of individuals ≥ 70 years) should be as low as possible. | May reduce the effect of diuretics and worsen existing heart failure. |
14. | 3 or more psychotropic drugs: • N02A* Analgesics containing opioids • N05* Psycholeptics: 1. antipsychotics 2. hypnotics 3. tranquillizers • N06A* Antidepressants | The share (% of individuals ≥ 70 years) receiving three or more different psychotropic drugs should be as low as possible. | Increased risk for excessive sedation, interactions and central nervous adverse effects. Increased risk for falls and fractures. |