Abstract
ObjectivesThe objectives of the present analyses are to estimate the frequency of potentially inappropriate prescribing (PIP) at admission according to STOPP/START criteria version 2 in older patients hospitalised due to chronic disease exacerbation as well as to identify risk factors associated to the most frequent active principles as potentially inappropriate medications (PIMs).MethodsA multicentre, prospective cohort study including older patients (≥65) hospitalized due to chronic disease exacerbation at the internal medicine or geriatric services of 5 hospitals in Spain between September 2016 and December 2018 was conducted. Demographic and clinical data was collected, and a medication review process using STOPP/START criteria version 2 was performed, considering both PIMs and potential prescribing omissions (PPOs). Primary outcome was defined as the presence of any most frequent principles as PIMs, and secondary outcomes were the frequency of any PIM and PPO. Descriptive and bivariate analyses were conducted on all outcomes and multilevel logistic regression analysis, stratified by participating centre, was performed on the primary outcome.ResultsA total of 740 patients were included (mean age 84.1, 53.2% females), 93.8% of them presenting polypharmacy, with a median of 10 chronic prescriptions. Among all, 603 (81.5%) patients presented at least one PIP, 542 (73.2%) any PIM and 263 (35.5%) any PPO. Drugs prescribed without an evidence-based clinical indication were the most frequent PIM (33.8% of patients); vitamin D supplement in older people who are housebound or experiencing falls or with osteopenia was the most frequent PPO (10.3%). The most frequent active principles as PIMs were proton pump inhibitors (PPIs) and benzodiazepines (BZDs), present in 345 (46.6%) patients. This outcome was found significantly associated with age, polypharmacy and essential tremor in an explanatory model with 71% AUC.ConclusionsPIMs at admission are highly prevalent in these patients, especially those involving PPIs or BZDs, which affected almost half of the patients. Therefore, these drugs may be considered as the starting point for medication review and deprescription.Trial registration numberNCT02830425
Highlights
Older patients with multiple morbidities and medication requirements pose a challenge to the prescribing physicians
Drugs prescribed without an evidence-based clinical indication were the most frequent potentially inappropriate medication (PIM) (STOPP criterion A1, in 33.8% of patients, many of them having multiple PIMs in this criterion, and accounting for 25.7% of the total number of PIMs)
potential prescribing omissions (PPO) relative to the total of patients are summarized in Figure 1B, starting with vitamin D supplement in older people who are housebound or experiencing falls or with osteopenia (START criterion E5, 10.3%), followed by laxatives in patients receiving opioids regularly (H2, 6.8%), beta-blockers with stable systolic heart failure (A8, 5.3%) and ACE inhibitors with systolic heart failure and/or documented coronary artery disease (A6, 5.1%)
Summary
Older patients with multiple morbidities and medication requirements pose a challenge to the prescribing physicians. The term potentially inappropriate prescribing (PIP) is being widely used to describe a range of situations in which prescribing should be revised, in geriatric patients. PIP includes potentially inappropriate medication (PIM) which, together with polypharmacy, are well-known risk factors for adverse drug events [3, 4], and includes potential prescribing omissions (PPO), which increase the probability of not taking essential medication [5, 6]. The explicit criteria STOPP/START (Screening Tool of Older Person’s potentially inappropriate Prescriptions / Screening Tool to Alert doctors to Right Treatment) [8], which includes PIMs and PPOs, were the first European criteria and are currently the most used and validated in European elderly people [9]. After the 1st version, containing 84 criteria, a 2nd version with 114 criteria was later developed, expanding the explicit criteria as well as incorporating three implicit criteria [10]
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