Characterising prescribing cascades in older community-dwelling adults attending general practice in The Netherlands: a retrospective cohort study

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dc.contributor.authorDoherty, A.S.
dc.contributor.authorPerry, Marieke
dc.contributor.authorMoriarty, Frank
dc.contributor.authorBoland, Fiona
dc.contributor.authorClyne, Barbara
dc.contributor.authorFahey, Tom
dc.contributor.authorO'Mahony, D.
dc.contributor.authorWallace, E.
dc.contributor.funderHealth Research Board, HRB, HRB-ECSA-2020–002
dc.date.accessioned2026-05-13T14:50:04Z
dc.date.available2026-05-13T14:50:04Z
dc.date.issued2026-03-17
dc.description.abstractBackground Prescribing cascades, where one medication is used to treat/prevent the adverse effects of another, have been the subject of increased research focus. However, few studies have confirmed potential prescribing cascades identified via administrative or dispensed medicines records with general practice patient record data. This study examined the incidence of ThinkCascades, a list of nine prescribing cascades of clinical relevance in older adults developed via international expert consensus, using general practice data in The Netherlands. Methods A retrospective cohort study examined prescribing records for adults aged ≥ 65 years captured within the FaMe-Net general practice database in The Netherlands for the period 2011–2021. The primary exposures were incident use of Drug A within each ThinkCascades dyad, with the primary outcomes defined as incident use of the corresponding Drug B within 365 days. Independent clinical review of identified potential prescribing cascades was conducted by a general practitioner and pharmacist using an approach consistent with methods applied in earlier prescribing cascade research. Results The eligible cohort comprised 710 incident users of any ThinkCascades Drug A. Their mean age was 75.8 (SD = 6.1) years; 53.5% (n = 380) were female. Overall, 21 ThinkCascades dyads were identified in 18 participants, representing a one-year incidence proportion of 2.5% (N = 710). Only six of nine ThinkCascades were identified amongst study participants, most commonly the calcium channel blocker to diuretic prescribing cascade. Just over one-quarter of identified potential prescribing cascades (6/21; 28.6%) were supported as true prescribing cascades based on independent clinical record review. True cascade likelihood was indeterminable for three cases. Conclusions Prescribing cascades, defined by ThinkCascades, were relatively uncommon over the eight-year study of older people attending Dutch general practice. Three of nine ThinkCascades were not identified. Only one in four identified prescribing cascades had evidence supporting a true prescribing cascade following independent clinical record review. Further research to characterise the prevalence of confirmed prescribing cascades is required. Recent research recommends expanding the number of prescribing cascade dyads which may impact identification rates. Tools to support prescribing cascade awareness, identification and deprescribing need to incorporate shared decision-making with patients and demonstrate clinical utility in supporting medication reviews in primary care.en
dc.description.sponsorshipThis publication has emanated from research conducted with the financial support of the Health Research Board under Grant number HRB-ECSA-2020–002 awarded to EW. The funder had no role in the design and conduct of the study
dc.description.sponsorshipdata analysis and interpretation
dc.description.sponsorshippreparation and review of the manuscript
dc.description.sponsorshipor decision to submit this for publication. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.
dc.description.versionPublished Version
dc.format.extent12
dc.format.mimetypeapplication/pdfen
dc.identifier.articleid156
dc.identifier.authororcidDoherty, A.S.
dc.identifier.authororcidPerry, Marieke
dc.identifier.authororcidMoriarty, Frank
dc.identifier.authororcidBoland, Fiona
dc.identifier.authororcidClyne, Barbara
dc.identifier.authororcidFahey, Tom
dc.identifier.authororcidO'Mahony, D.§0000-0003-2236-5222
dc.identifier.authororcidWallace, E.§0000-0002-9315-2956
dc.identifier.citationDoherty, A S, Perry, M, Moriarty, F, Boland, F, Clyne, B, Fahey, T, O'Mahony, D & Wallace, E 2026, 'Characterising prescribing cascades in older community-dwelling adults attending general practice in The Netherlands: a retrospective cohort study', BMC Primary Care, vol. 27, no. 1, 156. https://doi.org/10.1186/s12875-026-03273-x
dc.identifier.doi10.1186/s12875-026-03273-x
dc.identifier.issn2731-4553
dc.identifier.issued1
dc.identifier.journaltitleBMC Primary Care
dc.identifier.otherRIS: urn:7290280C1AE1BF1A85EBD323E8118003
dc.identifier.otherORCID: /0000-0003-2236-5222/work/214602121
dc.identifier.otherORCID: /0000-0002-9315-2956/work/214602537
dc.identifier.urihttps://hdl.handle.net/10468/18757
dc.identifier.volume27
dc.language.isoen
dc.publisherBioMed Central Ltd
dc.relation.urihttps://www.scopus.com/pages/publications/105036832458
dc.relation.urihttps://www.scopus.com/pages/publications/105036832458?origin=resultslist
dc.rightsPublisher Copyright: © The Author(s) 2026.
dc.rights.accessrightsopen access
dc.rights.licensenameAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.statusPeer reviewed
dc.subjectAdult
dc.subjectAged
dc.subjectArticle
dc.subjectCohort analysis
dc.subjectCommunity
dc.subjectElectronic medical health records
dc.subjectFemale
dc.subjectGeneral practice
dc.subjectHuman
dc.subjectMale
dc.subjectMiddle aged
dc.subjectNetherlands
dc.subjectNormal human
dc.subjectOlder adults
dc.subjectPotentially inappropriate medication
dc.subjectPotentially inappropriate prescribing
dc.subjectPrescribing cascade
dc.subjectPrescribing cascades
dc.subjectRetrospective study
dc.subjectSpecial situation for pharmacovigilance
dc.subjectVery elderly
dc.subject[Medicine]
dc.titleCharacterising prescribing cascades in older community-dwelling adults attending general practice in The Netherlands: a retrospective cohort studyen
dc.typeArticle (peer-reviewed)
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