Abstract
Purpose : To compare the prevalence and type of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) on admission and discharge of patients, and to determine the associated predictors. Methods : This was a prospective observational study conducted in the multidisciplinary medical and surgical units of Hospital Tengku Ampuan Afzan (HTAA), Malaysia. The medications of patients who had been admitted to the hospital from community-dwelling settings were reviewed to identify PIMs/PPOs using version 2 of STOPP/START criteria. A logistic regression model was applied to detect the risk factors associated with PIM or PPO at discharge. Results : Among the 300 patients involved in the study, the prevalence of PIMs was 27 % upon admission, which decreased to 22.3 % at discharge (p = 0.014) with PIMs pertaining to increasing the risk of physical falls in elderly people being the most common for pre- and post-hospitalization. The prevalence of PPOs was 47.6 % upon admission, which increased to 48 % at discharge (p = 0.99), with the omission of musculoskeletal medications being the most common PPOs at admission and discharge. Having a PIM at discharge was associated with the number of discharge medications and the history of falls, whereas having a high comorbidity index score or history of falls was associated with having a PPO at discharge. Conclusion : Hospitalization significantly reduces the prevalence of PIMs, but not PPOs or polypharmacy, among elderly patients. The number of discharge medications and the history of falls are predictors of discharge PIM, whilst high comorbidities and the history of falls were the predictors of discharge PPO. Improving the knowledge of hospital practitioners regarding geriatric pharmacotherapy is required to optimize prescribing in elderly patients during hospitalization. Keywords : Hospitalization, STOPP criteria, START criteria, Inappropriate prescribing, Co-morbidity, Polypharmacy, Elderly patients
Highlights
Inappropriate prescribing (PIP) occurs when there is prescribing of a potentially inappropriate medication (PIM), where the risks associated with the medication outweigh the expected benefits, or when there is a potential prescribing omission (PPO), where a specific-©---2-0--1--8--T--h--e--a--u-t-h--o--r-s-.--T--h-i-s--w---o-r-k---is---li-c-e--n--s-e--d--u--n--d-e--r--t-h-e---C--r-e--a-t-i-v-e---C--o--m--m-T--or-n-o-sp---AJ-t-Pt-r-hi-b-au-r-t-mi-o-n-R--4e-.-s0,--JI-na-t-ne-u-r-na--ar-yt-i-o2-n-0-a-1-l8-L-;-ic-1-e-7-n(-1s--e)-:--1--5-1 medication is indicated but not yet prescribed [1,2]
This study reported the influence of hospitalization on the prevalence of polypharmacy and Potentially inappropriate prescribing (PIP), as defined by the screening tool of older persons’ prescriptions (STOPP)/START criteria, among hospitalized community-dwelling elderly patients
The findings of this study indicate that hospitalization reduces the prevalence of preadmission PIMs among community-dwelling elderly patients
Summary
Inappropriate prescribing (PIP) occurs when there is prescribing of a potentially inappropriate medication (PIM), where the risks associated with the medication outweigh the expected benefits, or when there is a potential prescribing omission (PPO), where a specific-©---2-0--1--8--T--h--e--a--u-t-h--o--r-s-.--T--h-i-s--w---o-r-k---is---li-c-e--n--s-e--d--u--n--d-e--r--t-h-e---C--r-e--a-t-i-v-e---C--o--m--m-T--or-n-o-sp---AJ-t-Pt-r-hi-b-au-r-t-mi-o-n-R--4e-.-s0-,--JI-na-t-ne-u-r-na--ar-yt-i-o2-n-0-a-1-l8-L-;-ic-1-e-7-n(-1s--e)-:--1--5-1 medication is indicated but not yet prescribed [1,2]. Inappropriate prescribing (PIP) occurs when there is prescribing of a potentially inappropriate medication (PIM), where the risks associated with the medication outweigh the expected benefits, or when there is a potential prescribing omission (PPO), where a specific. PIP is highly common in older adults[9]; and because of physiological and pathological changes occurring with advancing age, the negative outcomes of PIPs in elderly patients are of great concern [1]. Inappropriate prescribing can be detected by either explicit or implicit criteria. Several explicit criteria have been formulated to identify PIPs in elderly patients. The STOPP list comprises 80 criteria for identifying PIMs that should be avoided, either in all elderly adults or when there is drug-disease or drug-drug interaction. The START list contains 34 criteria that address the common PPOs
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