Janine Cooper

Janine has a particular interest in inappropriate prescribing, multimorbidity and polypharmacy. According to Janine, “Prescribing for patients with two or more long-term conditions, or multimorbidity, is now common practice in primary care and is often associated with the use of multiple medications, or polypharmacy, which increases the risk of potentially inappropriate prescribing. However, polypharmacy may be necessary in many conditions, and the appropriateness of prescribing may be assessed using explicit prescribing criteria”.

Over the past number of years, Janine has been looking at medication use in the ageing population. She says: “There has been a paucity of research in potentially inappropriate prescribing in middle-aged adults, despite approximately one-third of this age-group living with multimorbidity. This population is particularly important as it represents a group which will be the focus for health provision in the future”.

Along with colleagues in the Royal College of Surgeons in Ireland, Trinity College Dublin and Queen’s University Belfast, Janine developed 11 12 a set of explicit criteria for middle-aged people known as PROMPT (PRescribing Optimally in Middle-aged People’s Treatments). In PROMPT, each criterion includes a statement about prescribing, for example, about doses, duration or medications to be avoided under certain conditions, and the rationale for this type of prescribing being potentially inappropriate.

In a recent study, these criteria have been applied to datasets from the Enhanced Prescribing Database in Northern Ireland and the Primary Care Reimbursement Service database in the Republic of Ireland to determine the prevalence of potentially inappropriate prescribing. “Our study found that potentially inappropriate prescribing is common amongst middle-aged people and that polypharmacy was most strongly associated with potentially inappropriate prescribing”. This work showed that the most frequent prescribing issues in this age group were the use of strong opioids without a laxative, longterm proton pump inhibitors above maintenance dose and long-term benzodiazepines.

Janine will be developing her research programme with further observational studies on multimorbid patients prescribed polypharmacy. Janine says: “Further work is needed, particularly to investigate health care outcomes, such as hospital admissions and medication-related problems, which may help to inform interventions to improve prescribing practices in this age group”.

RESEARCH PARTNERS

• Health Research Board Centre for Primary Care Research
• Royal College of Surgeons in Ireland
• Trinity College Dublin