Evidence-based application of explicit criteria to assess the appropriateness of geriatric prescriptions at admission and hospital stay.

Enrica Di Martino,Alessio Provenzani,Piera Polidori,Vincenzo De Luca

doi:10.1371/journal.pone.0238064

Abstract

BackgroundInappropriate prescribing in the elderly is a critical issue in primary care, causing a higher risk of Adverse Drug Reactions (ADRs) and resulting in major patient safety concerns. At international level, many tools have been developed to identify Potentially Inappropriate Medications (PIMs).ObjectiveThe aim of this study was the application of Beers, Screening Tool of Older People's Prescriptions (STOPP)/Screening Tool to Alert to Right Treatment (START) and Improving Prescribing in the Elderly Tool (IPET) criteria as key tool to improve the quality of prescribing.MethodsA retrospective study was conducted using the aforementioned criteria. Two different cohorts of elderly patients were enrolled between January 2015 and December 2016, 1800 at admission and 1466 at hospital stay. The index of each criterion divided by politherapy were correlated with comorbidities (Pearson correlation). A comparison was made between admission and hospital stay through a Student's t test of the average of the index.ResultsThe Proton Pump Inhibitors (PPIs) were the most prescribed PIMs according Beers criteria in both patient cohorts (56%). The most detected drug-drug and drug-disease interactions at admission and at hospital stay were 3 or more drugs active on the Central Nervous System (CNS) as they can predispose to fall-risk. The most detected PIMs with STOPP criteria at admission were PPIs administered for more than 8 weeks. Inhaled β2-agonists or antimuscarinics were the most prescribed Potential Prescription Omissions (PPOs) according to START criteria. Nonsteroidal Anti-inflammatory Drugs (NSAIDs) in patients with high blood pressure were the most detected PIMs according to IPET criteria during hospital stay. A significant correlation between the comorbidities and the all index at hospital stay, while at admission there was no significant correlation for Beers and IPET index.ConclusionThe prescriptive criteria were a useful tool for assessing the quality of prescriptions in the geriatric population and identifying their critical issues.

Highlights

In recent decades, the demographic change in the population has resulted in an increase in life expectancy with a consequent rapid aging of the population worldwide
The most detected drug-drug and drug-disease interactions at admission and at hospital stay were 3 or more drugs active on the Central Nervous System (CNS) as they can predispose to fall-risk
Nonsteroidal Anti-inflammatory Drugs (NSAIDs) in patients with high blood pressure were the most detected Potentially Inappropriate Medications (PIMs) according to IPET criteria during hospital stay

Summary

Introduction

The demographic change in the population has resulted in an increase in life expectancy with a consequent rapid aging of the population worldwide. Patients, defined as patients over 65 years [2], are at increased risk of ADRs [3] due to age-related physiological changes with consequent alteration of the normal response to pharmacological therapy These physiological changes are complex and depend on numerous factors, including the composition of the body mass, the health conditions of the various organs and the activity of the enzymatic systems [4,5,6]. All these conditions are emphasized by the use of multiple medications which makes it difficult to prescribe drugs with the right risk-benefit ratio [7]. Many tools have been developed to identify Potentially Inappropriate Medications (PIMs)

Methods

Results

Conclusion