Researchers have proposed a new metric for identifying low-value medication prescribing in older adults, according to a recent article in JAMA Network Open. Low-value prescribing is a common practice whereby doctors prescribe drugs with marginal benefits and substantial potential harms to older adults with chronic conditions. 

The metric, Evaluating Opportunities to Decrease Low-Value Prescribing (EVOLV-Rx), is a practical list of low-value drugs and prescribing practices that should not be started or should be stopped. It also helps identify at-risk patients. EVOLV-Rx Criteria for inclusion in the metric include: lack of effectiveness because of inappropriately prolonged use, potential harm because of the risk of an adverse drug event or drug interaction, excessive cost because of the use of brand-name medication, and use of a medication to treat the adverse effect of another drug.

The authors reviewed the 100 most frequently prescribed medications among Medicare beneficiaries to identify the most frequently prescribed drugs. They also formed a panel of experts composed of physicians, pharmacists, and health system leaders to refine the criteria for the practices included in EVOLV-Rx.

EVOLV-Rx is another important tool for improving prescribing practices, the authors contend. One example of how the metric works is the use of a benzodiazepine for a period of more than four weeks. Long-term use of this medication class is associated with increased risk of falls and fractures in older patients. The tool identifies patients who have a concurrent prescription for any other psychoactive medication that could further increase risk, and it flags the brand-name products.