Abstract
BackgroundAppropriateness of prescribing can be assessed by various measures and screening instruments. The aims of this study were to investigate the effects of pharmacists' interventions on appropriateness of prescribing in elderly patients, and to explore the relationship between these results and hospital care utilization during a 12-month follow-up period.MethodsThe study population from a previous randomized controlled study, in which the effects of a comprehensive pharmacist intervention on re-hospitalization was investigated, was used. The criteria from the instruments MAI, STOPP and START were applied retrospectively to the 368 study patients (intervention group (I) n = 182, control group (C) n = 186). The assessments were done on admission and at discharge to detect differences over time and between the groups. Hospital care consumption was recorded and the association between scores for appropriateness, and hospitalization was analysed.ResultsThe number of Potentially Inappropriate Medicines (PIMs) per patient as identified by STOPP was reduced for I but not for C (1.42 to 0.93 vs. 1.46 to 1.66 respectively, p<0.01). The number of Potential Prescription Omissions (PPOs) per patient as identified by START was reduced for I but not for C (0.36 to 0.09 vs. 0.42 to 0.45 respectively, p<0.001). The summated score for MAI was reduced for I but not for C (8.5 to 5.0 and 8.7 to 10.0 respectively, p<0.001). There was a positive association between scores for MAI and STOPP and drug-related readmissions (RR 8–9% and 30–34% respectively). No association was detected between the scores of the tools and total re-visits to hospital.ConclusionThe interventions significantly improved the appropriateness of prescribing for patients in the intervention group as evaluated by the instruments MAI, STOPP and START. High scores in MAI and STOPP were associated with a higher number of drug-related readmissions.
Highlights
Appropriateness of prescribing can be assessed by various measures and screening instruments
The change from admission to discharge in Medication Appropriatness Index (MAI), Screening Tool of Older Persons’ Prescriptions (STOPP) and START scores differed significantly between the intervention and control groups
The MAI, STOPP and START scores improved in 60%, 42% and 21%, respectively, in the intervention group compared to 11%, 8% and 4% of patients, respectively, in the control group (Figure 1A)
Summary
Appropriateness of prescribing can be assessed by various measures and screening instruments. The question of how to ensure safe effective prescribing for this increasing patient population represents a major challenge for our societies In this context, there is a growing interest in developing methods of measuring the appropriateness of prescribing. The best known and most often used criterion-based instrument, the Beers’ criteria [12,13,14,15], has been well studied regarding its ability to predict mortality, use of health-care services, ADEs and quality of life. The Medication Appropriatness Index (MAI) [27,28], a judgment-based instrument, has been used extensively in research [26,29,30,31,32] It has been used in several studies as a reference when assessing the ability of screening instruments to identify inappropriate prescribing [33,34]. Studies that test the predictive ability of instruments that measure inappropriate prescribing for elderly people are required
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