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\begin{document}

\title{Prevalence of potentially suboptimal prescribing and associated
cognitive risk in Aboriginal primary care}



\author[1]{ Marycarol  Holdaway}%
\author[2]{Zoë Hyde}%
\author[1]{Jo-anne Hughson}%
\author[2]{Roslyn  Malay}%
\author[3]{Andrew Stafford}%
\author[2]{Kate Fulford}%
\author[4]{Kylie Radford}%
\author[2]{Leon Flicker}%
\author[2]{Kate Smith}%
\author[5]{Constance Dimity Pond}%
\author[6]{Sarah Russell}%
\author[2]{David Atkinson}%
\author[7]{Irene Blackberry}%
\author[1]{Dina LoGiudice}%
\affil[1]{The University of Melbourne Medicine at Royal Melbourne Hospital}%
\affil[2]{The University of Western Australia}%
\affil[3]{Curtin University Faculty of Health Sciences}%
\affil[4]{Neuroscience Research Australia}%
\affil[5]{The University of Newcastle}%
\affil[6]{James Cook University College of Medicine and Dentistry}%
\affil[7]{La Trobe University Rural Health School}%


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  \date{May 24, 2024}


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\begin{abstract}
Aim Prevalence of potentially suboptimal prescribing and associated risk
factors were investigated among older patients attending primary care
via Aboriginal Community Controlled Health Services (ACCHSs). Methods
Prescription medications were audited for 420 systematically selected
patients aged [?]50 years at three ACCHSs in urban, rural, and remote
settings. Polypharmacy, potentially inappropriate medications (PIMs),
and anticholinergic burden (ACB) were estimated and associated risk
factors explored with logistic regression. Results The prevalence of
polypharmacy, use of PIMs, and ACB score [?]3, was 43\%, 18\%, and 12\%,
respectively. In multivariable logistic regression analyses,
polypharmacy was less likely in rural (OR=0.43, 95\% CI=0.24-0.77)
compared to urban health service patients, and more likely in those with
heart disease (OR=2.62, 95\% CI=1.62-4.25), atrial fibrillation
(OR=4.25, 95\% CI=1.08-16.81), hypertension (OR=2.14, 95\%
CI=1.34-3.44), diabetes (OR=2.72, 95\% CI=1.69-4.39), or depression
(OR=1.91, 95\% CI=1.19-3.06). PIMs were more frequent in females
(OR=1.88, 95\% CI=1.03-3.42), and less frequent in rural (OR=0.41, 95\%
CI=0.19-0.85) and remote (OR=0.58, 95\% CI=0.29-1.18) patients. Factors
associated with PIMs were kidney disease (OR=2.60, 95\% CI=1.37-4.92),
urinary incontinence (OR=3.00, 95\% CI=1.02-8.83), depression (OR=2.67,
95\% CI=1.50-4.77), heavy alcohol use (OR=2.83, 95\% CI 1.39-5.75) and
subjective cognitive concerns (OR=2.69, 95\% CI=1.31-5.52). High
anticholinergic burden was less common in rural (OR=0.10, 95\% CI
0.03-0.34) and remote (OR=0.51, 95\% CI 0.25-1.04) patients, and more
common in those with kidney disease (OR=3.07, 95\% CI 1.50-6.30), or
depression (OR=3.32, 95\% CI 1.70-6.47). Conclusion Associations between
potentially suboptimal prescribing and depression or cognitive concerns
highlights the importance of considered medication review and
deprescribing for these patients.%
\end{abstract}%



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