Abstract
PurposePotentially inappropriate prescribing (PIP) is a source of preventable adverse drug events. The objective of this study was a comparative analysis (quantitative and qualitative) between two tools used to detect PIP, PIM-Check and STOPP/START.MethodsFirst, a qualitative analysis (QAC) was conducted to evaluate the concordance between the criteria, which constitute PIM-Check and the gold standard STOPP/START. Second, a retrospective comparative and observational study was performed on the list of treatment at the admission of 50 older patients hospitalized in an acute geriatric ward of a university hospital in Switzerland in 2016 using both tools.ResultsThe QAC has shown that 50% (57 criteria) of STOPP/START criteria are fully or partially concordant with those of PIM-Check. The retrospective study was performed on 50 patients aged 87 years, suffering from 5 co-morbidities (min–max 1–11) and treated by of 8 drugs (min–max 2–16), as medians. The prevalence of the detected PIP was 80% by PIM-Check and 90% by STOPP/START. Medication review shows that 4.2 PIP per patient were detected by PIM-Check and 3.5 PIP by STOPP/START among which 1.9 PIP was commonly detected by both tools, as means. PIM-Check detected more PIP related to cardiology, angiology, nephrology, and endocrinology in older patients but missed the PIP related to geriatric syndromes (e.g., fall, dementia, Alzheimer) detected by STOPP/START.ConclusionsBy using PIM-Check in geriatric settings, some PIP will not be detected. It is considered as a limitation for this tool in this frail population but brings a certain complementarity in other areas of therapy not covered by STOPP/START.
Highlights
Inappropriate prescribing (PIP) involves the use of medications where the risk of adverse drug events (ADEs) surpasses the clinical benefits, especially when safer or more effective alternatives are available [1]
We report the results of qualitative and quantitative analyses measuring to which extent potentially inappropriate medications (PIMs)-Check could expand the scope of Potentially inappropriate prescribing (PIP) detection in older patients compared to the STOPP/START set of criteria in a geriatric population
The qualitative comparison between the 160 PIM-Check and the 114 STOPP/START criteria showed that 50% (57 criteria) of STOPP/START criteria were concordant with those of PIM-Check, with only 4 couples (7%) fully concordant and 53 couples (93%) partially concordant
Summary
Inappropriate prescribing (PIP) involves the use of medications where the risk of adverse drug events (ADEs) surpasses the clinical benefits, especially when safer or more effective alternatives are available [1]. PIP includes the use of drugs that increase the likelihood of drug-drug and drug-disease interactions, the School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland. PIP are highly prevalent in older patients and have been associated with preventable ADEs, hospitalization, institutional admission, death, and resource wastage [2,3,4,5,6]. One of the effective ways to limit PIP is medication review through the use of sets of explicit criteria [2, 11], which are lists of drugs to be avoided or introduced, based on a consensus of experts, in order to support improvements of the therapy [2]. Application of STOPP/START combined with education of physicians and pharmacists has been shown to be effective in optimizing prescription and minimizing PIP in this population and is becoming the reference tool in Europe [14, 15]
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