Abstract
BackgroundPotentially inappropriate prescribing (PIP) in older people is associated with increases in morbidity, hospitalisation and mortality. The objective of this study was to estimate the prevalence of and factors associated with PIP, among those aged ≥70 years, in the United Kingdom, using a comprehensive set of prescribing indicators and comparing these to estimates obtained from a truncated set of the same indicators.MethodsA retrospective cross-sectional study was carried out in the UK Clinical Practice Research Datalink (CPRD), in 2007. Participants included those aged ≥ 70 years, in CPRD. Fifty-two PIP indicators from the Screening Tool of Older Persons Potentially Inappropriate Prescriptions (STOPP) criteria were applied to data on prescribed drugs and clinical diagnoses. Overall prevalence of PIP and prevalence according to individual STOPP criteria were estimated. The relationship between PIP and polypharmacy (≥4 medications), comorbidity, age, and gender was examined. A truncated, subset of 28 STOPP criteria that were used in two previous studies, were further applied to the data to facilitate comparison.ResultsUsing 52 indicators, the overall prevalence of PIP in the study population (n = 1,019,491) was 29%. The most common examples of PIP were therapeutic duplication (11.9%), followed by use of aspirin with no indication (11.3%) and inappropriate use of proton pump inhibitors (PPIs) (3.7%). PIP was strongly associated with polypharmacy (Odds Ratio 18.2, 95% Confidence Intervals, 18.0-18.4, P < 0.05). PIP was more common in those aged 70–74 years vs. 85 years or more and in males. Application of the smaller subset of the STOPP criteria resulted in a lower PIP prevalence at 14.9% (95% CIs 14.8-14.9%) (n = 151,598). The most common PIP issues identified with this subset were use of PPIs at maximum dose for > 8 weeks, NSAIDs for > 3 months, and use of long-term neuroleptics.ConclusionsPIP was prevalent in the UK and increased with polypharmacy. Application of the comprehensive set of STOPP criteria allowed more accurate estimation of PIP compared to the subset of criteria used in previous studies. These findings may provide a focus for targeted interventions to reduce PIP.
Highlights
Inappropriate prescribing (PIP) in older people is associated with increases in morbidity, hospitalisation and mortality
Potentially inappropriate prescribing (PIP) is prevalent among older people across the United Kingdom (UK), and is more accurately estimated by applying a comprehensive set of STOPP criteria to databases such as Clinical Practice Research Datalink (CPRD), compared to the truncated version used in previous studies, on more limited databases
Suggested approaches in the UK have included identifying the main PIP issues nationally and the use of alert systems in the computers of primary care physicians to identify PIP at the time of prescribing [43]. Such systems have effectively reduced the level of newly prescribed inappropriate medications in the United States (US) [44] and similar pharmacist-led information technology interventions in the UK reduced medication errors in primary care, indicating the potential for future development [45]
Summary
Inappropriate prescribing (PIP) in older people is associated with increases in morbidity, hospitalisation and mortality. The United States (US) Beers criteria, the most commonly used explicit process measure for assessing potentially inappropriate prescribing (PIP) in older people, has been widely validated [6,7], but has some limitations; for example, approximately 50% of the Beers drugs are unavailable in European countries [8]. The recently developed ‘Screening Tool of Older Persons potentially inappropriate Prescriptions’ (STOPP) provides a more comprehensive explicit process measure of PIP, is validated for use in European countries [9], and overcomes some of the limitations inherent in the Beers criteria. STOPP is a physiological system-based screening tool comprising 65 clinically significant criteria which take drug-drug and drug-disease interactions, drug doses and duration of treatment into consideration It considers clinical effectiveness and the removal of any potentially unnecessary drugs as well as drug duplication
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