Prevalence Of Potential Prescribing Omissions Research Articles

The Prevalence of Potential Prescribing Omissions for Antiplatelets and Statins in Older Adults With Atherosclerotic Cardiovascular Disease.

Background The Screening Tool to Alert to Right Treatment (START) criteria for older adults was developed to recognize potential prescribing omissions (PPOs) of clinically indicated medications. According to these criteria, statins and antiplatelets should be prescribed for older adults with a documented history of coronary artery, cerebral, or peripheral vascular disease unless contraindicated. Aim This study aimed to investigate physicians' adherence to START criteria and identify the prevalence of PPO, considering the prescription of statins and antiplatelets in older patients with a history of coronary artery, cerebral, or peripheral vascular disease. Methods In this single-center, cohort, retrospective study, patients aged >65 years with a history of coronary artery, cerebral, or peripheral vascular disease were included. The prevalence of PPO for statins and antiplatelet therapy was identified. This study was guided by the screening Tool of Older Persons'Prescriptions (STOPP)/START criteria published in 2016. Results A total of 244 patients with a history of coronary, cerebral, or peripheral vascular disease were included in this study. Statin use was appropriately observed in 131/220 (59.5%)while antiplatelets were appropriately observed in 219/237 (92.4%). Therefore, the PPO for statins and antiplatelets was 40.5% and 7.6%, respectively. Conclusion The results of this study identified that the prevalence of PPO for statins and antiplatelets for older adults was high. We encourage prescribers to utilize tools such as Beer's criteria or STOPP/START, which may assist their decision in addition to their clinical judgment in weighing the benefit to the risk of starting or stopping antiplatelets or statins in older adult patients.

Medication Evaluation in Portuguese Elderly Patients According to Beers, STOPP/START Criteria and EU(7)-PIM List - An Exploratory Study.

PurposeThe increase in drug prescription for the elderly raises the risk of the occurrence of potentially inappropriate medications (PIMs), thus increasing the incidence of drug-related problems. Likewise, potential prescribing omissions (PPOs) are also highly prevalent in the elderly. This study aimed at assessing the prevalence of PIMs in the elderly by using the EU(7)-PIM list, STOPP criteria version 2 and the Beers criteria version 2015, as well as the prevalence of PPOs by applying the START criteria version 2 in elderly nursing home residents and outpatients of the Eastern Central Region of Portugal.Patients and MethodsA descriptive cross-sectional study was carried out in a sample of 90 Portuguese elderly people. Age, gender, diagnoses and medication history were collected from the patients’ clinical records. The prevalence of PIMs and PPOs was measured according to each of the criteria applied.ResultsThe patients’ ages ranged from 65 to 103 years, with an average age of 84.15 years. In addition, the average number of medications prescribed was 7.6. The STOPP criteria identified 250 PIMs affecting 77 patients (85.5%), the EU(7)-PIM list detected 94 PIMs in 58 patients (64.4%) and the Beers criteria identified 69 PIMs in 51 patients (56.6%). Therefore, the STOPP criteria version 2 identified substantially more PIMs than the other two tools. Furthermore, by applying the START criteria 68 PPOs were detected in 52 patients (57.7%).ConclusionA high prevalence of PIMs and PPOs was observed, suggesting the need to implement actions aimed at reducing the phenomenon and thus help to improve the quality of care provided in nursing homes. The variations in prevalence with the different tools suggest the need to carefully choose the tool for medication review in the elderly.

Prevalence of potentially inappropriate prescribing in a subpopulation of older European clinical trial participants: a cross-sectional study

ObjectivesTo estimate and compare the prevalence and type of potentially inappropriate prescribing (PIP) and potential prescribing omissions (PPOs) among community-dwelling older adults (≥65 years) enrolled to a clinical trial in...

Influence of hospitalization on potentially inappropriate prescribing among elderly patients in a Malaysian community

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

Potentially inappropriate medications in a sample of Portuguese nursing home residents: Does the choice of screening tools matter?

Background Potentially inappropriate medications (PIMs) are often found in high proportion among the elderly population. The STOPP criteria have been suggested to detect more PIMs in European elderly than the Beers criteria. Objective This study aimed to determine the prevalence of PIMs and potential prescribing omissions (PPOs) in a sample of Portuguese nursing homes residents. Setting Four elderly facilities in mainland Portugal Method A descriptive cross-sectional study was used. Elderly polypharmacy patients were included in the study and their medication (registered in patient clinical records) analysed using the Beers (2012 original version and 2008 version adapted to Portugal), STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) criteria. Data were analysed using univariate and bivariate descriptive statistics, considering a confidence interval of 95%. Prevalence of PIMs and PPOs. Results The sample included 161 individuals, with a mean age of 84.7years (SD=6.35), 68.9% being female. A total of 807 PIMs and 90 PPOs were identified through the application of the three set of criteria. The prevalence of PIMs using the most recent version of the Beers criteria was 85.1 and 42.1% for independent and dependent of diagnosis, respectively. The Portuguese adaptation of this same tool indicated a lower prevalence of PIMs, 60.3 and 16.7%, respectively. The prevalence of PIMs using the STOPP criteria was 75.4%, whilst the prevalence of PPOs, using START, was 42.9%. There were significant differences in the mean number of PIMs detected depending on the tool used. (p<0.001). Conclusions The application of the studied criteria in an elderly sample enabled the identification of a notable amount of PIMs and PPOs, indicating there is room for improving the quality of care. The variation in prevalence indicates careful choice of the tool is a prerequisite for engaging in medication review. Using START/STOPP criteria enabled a more holistic approach to the quality of prescribing in the elderly, highlighting low levels of cardiovascular risk prevention and abuse of psychotropic drugs, aside with system failures largely preventable by electronic prescribing and alert generation.

Prevalence of potentially inappropriate prescribing and prescribing omissions in older Irish adults: findings from The Irish LongituDinal Study on Ageing study (TILDA)

PurposeWe sought to estimate the prevalence of potentially inappropriate prescriptions (PIP) and potential prescribing omissions (PPOs) using a subset of the STOPP/START criteria in a population based sample of Irish adults aged ≥65 years using data from The Irish LongituDinal Study on Ageing (TILDA).MethodsA subset of 26 PIP indicators and 10 PPO indicators from the STOPP/START criteria were applied to the TILDA dataset. PIP/PPO prevalence according to individual STOPP/START criteria and the overall prevalence of PIP/PPO were estimated. The relationship between PIP and PPOs and polypharmacy, age, gender and multimorbidity was examined using logistic regression.ResultsThe overall prevalence of PIP in the study population (n = 3,454) was 14.6 %. The most common examples of PIP identified were NSAID with moderate-severe hypertension (200 participants; 5.8 %) and aspirin with no history of coronary, cerebral, or peripheral vascular symptoms or occlusive event (112 participants; 3.2 %). The overall prevalence of PPOs was 30 % (n = 1,035). The most frequent PPO was antihypertensive therapy where systolic blood pressure consistently >160 mmHg (n = 341, 9.9 %), There was a significant association between PIP and PPO and polypharmacy when adjusting for age, sex and multimorbidity (adjusted OR 2.62, 95 % CI 2.05–3.33 for PIP and adjusted OR 1.46, 95 % CI 1.23–1.75 for prescribing omissions).ConclusionOur findings indicate prescribing omissions are twice as prevalent as PIP in the elderly using a subset of the STOPP/START criteria as an explicit process measure of potentially inappropriate prescribing and prescribing omissions. Polypharmacy was independently associated with both PPO and PIP. Application of such screening tools to prescribing decisions may reduce unnecessary medication, related adverse events, healthcare utilisation and cost.Electronic supplementary materialThe online version of this article (doi:10.1007/s00228-014-1651-8) contains supplementary material, which is available to authorized users.