Abstract
ObjectivesThe aim of the study was to determine the rate of Potentially Inappropriate Medicines (PIM) and Potential Prescription Omissions (PPO) according to Screening Tool of Older Person's potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment (STOPP/START) criteria.Study DesignA cross-sectional survey in community pharmacy.MethodA prospective cross-sectional study was performed, during March-May 2012, in five community pharmacies. Patients aged ≥65 years, who collected one or more prescribed medications, were asked to participate in the study, and an interview was scheduled. Patients were asked to provide their complete medical and biochemical record from their general practitioner.Results509 patients, mean age 74.8±6.5 years, 57.4% female, participated in the study. 164 PIM were identified in 139 patients (27.3%). The most common were: long-term use of long-acting benzodiazepines (20.7%), use of non-steroidal antiinflammatory drugs (NSAID) in patients with moderate-severe hypertension (20.1%), use of theophylline as monotherapy for chronic obstructive pulmonary disease (COPD, 15.9%) and use of aspirin without appropriate indication (15.2%). Patients with more than four prescpritions had a higher risk for PIM (OR 2.85, 95% CI 1.97–4.14, p<0.001). There were 439 PPO, identified in 257, (50.5%) patients. Predictors for PPO were older age, presence of diabetes, myocardial infarction, osteoporosis, stroke, COPD and/or angina pectoris.ConclusionSTOPP/START criteria may be useful in identifying inappropriate prescribing and improving the current prescribing practices. Pharmacists should focus more on patients with more than four medications and/or patients with gout or pain accompanied with arterial hypertension because those patient may be at higher risk of PIM. Additionlly, patients older than 74 years with diabetes, osteoporosis, myocardial infarction, stroke, angina pectoris and/or COPD may have an increased risk of PPO.
Highlights
Older people have an increased risk of multimorbidity and are more likely to be prescribed several medications concomitantly, which increases the risk of adverse drug events (ADE) [1]
Patients with more than four prescpritions had a higher risk for Potentially Inappropriate Medicines (PIM)
Pharmacists should focus more on patients with more than four medications and/or patients with gout or pain accompanied with arterial hypertension because those patient may be at higher risk of PIM
Summary
Older people have an increased risk of multimorbidity and are more likely to be prescribed several medications concomitantly, which increases the risk of adverse drug events (ADE) [1]. Beers’ criteria have several limitations since drug-drug interactions and potentially inappropriate drug omissions are not considered which may lead to underestimation of potentially inappropriate prescribing. Another tool called STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) has been developed by an Irish group of authors [8]. STOPP criteria consist of 65 indicators which detect Potentially Inappropriate Medicines (PIM) including drug-drug and drug-disease interactions. Recent reviews endorse the use of STOPP/START over Beers’ criteria in detecting inappropriate prescribing in the elderly [9,10,11]
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