Screening Tool Of Older Person's Prescriptions Criteria Research Articles

Potentially inappropriate prescriptions and potential prescription omissions in older people living with HIV.

This study aimed to determine the prevalence of potentially inappropriate prescriptions (PIPs) and potential prescription omissions (PPOs) in a Spanish cohort of people living with HIV (PLWH) aged ≥65 years and to identify risk factors for the presence of PIPs and PPOs. This retrospective cross-sectional study was conducted across 10 public hospitals in the Autonomous Community of Madrid, Spain. Clinical and demographic data were cross-checked against hospital and community pharmacy dispensation registries. PIPs and PPOs were assessed using the American Geriatrics Society (AGS)/Beers and Screening Tool of Older Persons' Prescriptions (STOPP)/Screening Tool to Alert Doctors to Right Treatment (START) criteria. Risk factors for PIPs and PPOs and agreement between AGS/Beers and STOPP/START criteria were statistically analysed. This study included 313 PLWH (median age 72 years), of whom 80.5% were men. PIP prevalence rates were 29.4% and 44.4% based on the AGS/Beers and STOPP criteria, respectively. The concordance between AGS/Beers and STOPP criteria was moderate. Benzodiazepines and proton pump inhibitors were the chronic comedications most commonly involved in PIPs. PPOs were observed in 61.4% of the patients. The leading omissions were insufficient influenza and pneumococcal vaccine coverage and inadequate bone health-related treatments. The number of chronic comedications, female sex, neuropsychiatric disorders, and cancer diagnosis were risk factors for PIPs, whereas osteopenia and osteoporosis were risk factors for PPOs. A high prevalence of PIPs and PPOs was observed in our cohort of older PLWH. These findings emphasize the importance of comprehensive medication reviews in this population to reduce inappropriate medication use and address their specific and underserved therapeutic needs.

Evaluation of potentially inappropriate medications for the elderly according to beers, STOPP, START, and Chinese criteria.

Objective: Polypharmacy prevalence is increasing worldwide, and it is becoming more popular among the elderly. This study aimed to compare the prevalence of potentially inappropriate medications (PIMs) using the Beers criteria (2019 edition), criteria for potentially inappropriate medications for older adults in China (Chinese criteria), Screening Tool of Older Persons' Prescriptions (STOPP), and Screening Tool to Alert to Right Treatment (START) criteria and to identify risk factors associated with PIM use. Methods: This was a cross-sectional study with a sample of 276 inpatients aged ≥65 years old from January 2020 to June 2020. A cross-sectional study was conducted to analyze PIMs based on the Beers (2019 edition), Chinese, STOPP, and START criteria. PIMs use was analysed based on four different criteria and logistic regression analysis was used to investigate independent factors associated with PIM use. Results: The mean number of medications used by the elderly population was nine (range, 0-28). A total of 252 patients (accounting for 91.30%) took five or more medications and 120 patients (accounting for 43.48%) took 10 or more medications. The prevalence rates of PIMs were 66.30% (183/276), 55.07% (152/276), 26.45% (73/276), and 64.13% (177/276) determined by the Beers, Chinese, STOPP, and START criteria, respectively. The top PIMs screened using the Beers, Chinese, and STOPP criteria were proton pump inhibitors, clopidogrel, and benzodiazepines, respectively. Missed use of ACEI in patients with systolic heart failure and/or coronary artery disease was found to be the most common potential prescription omission (PPOs) analyzed using the START criteria. Logistic regression analysis showed that the strongest predictor of PIMs, as determined by all four criteria, was an increased number of medications (p < 0.001). Age was another risk factor for PIMs based on the STOPP criteria in our study (p < 0.05). Conclusion: Polypharmacy and PIMs were common in our study, and the risk of PIMs correlated with polypharmacy. Application of the Beers, Chinese, STOPP, and START criteria is a useful tool for detecting PIM use.

A combination of Beers and STOPP criteria better detects potentially inappropriate medications use among older hospitalized patients with chronic diseases and polypharmacy: a multicenter cross-sectional study

BackgroundResearch on potentially inappropriate medications (PIM) and medication-related problems (MRP) among the Chinese population with chronic diseases and polypharmacy is insufficient.ObjectivesThis study aimed to investigate the prevalence of PIM and MRP among older Chinese hospitalized patients with chronic diseases and polypharmacy and analyze the associated factors.MethodsA retrospective cross-sectional study was conducted in five tertiary hospitals in Beijing. Patients aged ≥ 65 years with at least one chronic disease and taking at least five or more medications were included. Data were extracted from the hospitals’ electronic medical record systems. PIM was evaluated according to the 2015 Beers criteria and the 2014 Screening Tool of Older Persons’ Prescriptions (STOPP) criteria. MRPs were assessed and classified according to the Helper-Strand classification system. The prevalence of PIM and MRP and related factors were analyzed.ResultsA total of 852 cases were included. The prevalence of PIM was 85.3% and 59.7% based on the Beers criteria and the STOPP criteria. A total of 456 MRPs occurred in 247 patients. The most prevalent MRP categories were dosages that were too low and unnecessary medication therapies. Hyperpolypharmacy (taking ≥ 10 drugs) (odds ratio OR 3.736, 95% confidence interval CI 1.541–9.058, P = 0.004) and suffering from coronary heart disease (OR 2.620, 95%CI 1.090–6.297, P = 0.031) were the influencing factors of inappropriate prescribing (the presence of either PIM or MRP in a patient).ConclusionPIM and MRP were prevalent in older patients with chronic disease and polypharmacy in Chinese hospitals. More interventions are urgently needed to reduce PIM use and improve the quality of drug therapies.

Prevalence and Associated Predictors of Inappropriate and Omitted Medications Prescribing in Older Patients with Advanced Cancer: A Cross-Sectional Study.

This study aimed to identify the prevalence and significant predictors of both potentially inappropriate medications (PIMs) and potentially omitted medications (POMs) events among geriatric patients with advanced cancer using the STOPP (Screening Tool of Older Persons' Prescriptions) and START (Screening Tool to Alert to Right Treatment) criteria. This retrospective cross-sectional study included patients aged ≥65 years who were diagnosed and treated for advanced stage of cancer. Patients' medical charts were evaluated to identify polypharmacy (≥5 medications) prevalence as well as potential PIMs and POMs incidents and their associated predictors. SPSS software was used to perform the analysis. Multivariate logistic regression models were used to identify factors associated with dependent variables including PIMs use and POMs. Electronic medication charts of 510 patients were evaluated. The average age of the patients was 73.25 years, and 264 (51.8%) patients were males. The average number of medications prescribed per patient was 10.3 (range-2-26). Polypharmacy was present in 85.9% of patients, while excessive polypharmacy prevalence was 52.2%. At least one PIM was encountered in 253 patients (49.6%), while at least one POM was encountered in all patients owing to the omission of pneumococcal vaccines. The most common PIMs were opioid analgesics, followed by benzodiazepines, and hypnotics. Additionally, the most omitted medications, excluding vaccinations, were cardiovascular agents and laxatives in patients on regular opioid analgesics. Polypharmacy and diagnosis with solid cancer compared to hematological cancer were associated with increased odds for PIMs occurrence (ORs = 1.293 (p < 0.001) and 3.022 (p = 0.03), respectively), while coexistence of hypertension diagnosis in cancer patients was associated with increased the odds for POMs events (OR = 2.286 (p = 0.007)). Polypharmacy, PIMs, and POMs were highly prevalent among older cancer patients based on the polypharmacy definition and STOPP/START Criteria.

166 INAPPROPRIATE PRESCRIBING IN COMMUNITY-DWELLING OLDER ADULTS: A CROSS SECTIONAL REVIEW USING THE STOPP/START CRITERIA

Abstract Background Older adults are a heterogenous cohort of patients, often with multiple comorbidities and prescribed numerous drugs. Polypharmacy, defined as use of five or more medications, and inappropriate prescribing are risk factors for adverse outcomes. STOPP (Screening Tool of Older Persons’ Prescriptions) and START (Screening Tool to Alert to Right Treatment) are criteria that facilitate medication review in older people to aid better prescribing and health outcomes. This review aims to identify inappropriate prescribing in the community-dwelling older adult attending Integrated Care Programme for Older Persons (ICPOP). Methods We performed a cross-sectional review of patients attending the ICPOP Hub between January 2022 and May 2022. Patients’ prescriptions were obtained from pharmacies and/or General Practitioners (GP) and cross checked against the medications brought to their appointment. Patients’ past medical history was obtained from the patient, GP and hospital letters. Their prescriptions were analysed using the STOPP/START criteria. Results This study included 68 patients. The mean age was 83.5 years. Polypharmacy was present in 94%, with an average of 9.5 drugs prescribed. Common medications identified via STOPP criteria were hypnotic z-drugs in patients with falls (13.2%); loop diuretics for pedal oedema without heart failure (11.8%) and benzodiazepines for &amp;gt;4 weeks in patients with falls (10.3%). Common medications identified to commence via START criteria were vitamin D supplement in those with falls (32.4%); bone anti-resorptive therapy in those with osteoporosis (13.2%); laxatives in patients taking opiates (11.8%) and acetylcholinesterase inhibitors in those with memory impairment (8.8%). 48 participants had medications commenced with 46 having medications stopped. Only 9 patients required no change to their medication prescription. Following STOPP/START, there was an overall reduction in prescribed medications by 0.12 (p=0.494). Conclusion Applying STOPP/START criteria lead to a reduction in inappropriate medications prescribed in our multi-morbid older people cohort while identifying appropriate treatments to improve health outcomes.

Revisiting the inter-rater reliability of drug treatment assessments according to the STOPP/START criteria.

The aim of this study is to revisit the inter-rater reliability of drug treatment assessments according to the Screening Tool of Older Persons' Prescriptions (STOPP)/Screening Tool to Alert to Right Treatment (START) criteria. Potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) were independently identified by two physicians in two cohorts of older people (I: 200 hip fracture patients, median age 85 years, STOPP/START version 1; II: 302 primary care patients, median age 74 years, STOPP/START version 2). Kappa statistics were used to evaluate inter-rater agreement. In cohort I, a total of 782 PIMs/PPOs, related to 68 (78%) out of 87 criteria, were identified by at least one assessor, 500 (64%) of which were discordantly identified by the assessors, that is, by one assessor but not the other. For four STOPP criteria, all PIMs (n = 9) were concordantly identified. In cohort II, 955 PIMs/PPOs, related to 80 (70%) out of 114 criteria, were identified, 614 (64%) of which were discordantly identified. For three STOPP criteria, all PIMs (n = 3) were concordantly identified. For no START criterion, with ≥1 PPO identified, were all assessments concordant. The kappa value for PIM/PPO identification was 0.52 in both cohorts. In cohort II, the kappa was 0.37 when criteria regarding influenza and pneumococcal vaccines were excluded. Further analysis of discordantly identified PIMs/PPOs revealed methodological aspects of importance, including the data source used and criteria wording. When the STOPP/START criteria are applied in PIM/PPO research, reliability seems to be an issue not encountered in previous reliability studies.

Comparison of the prevalence and nature of potentially inappropriate medication use in geriatric outpatients between tertiary and community healthcare settings: a multicenter cross-sectional study.

Background Geriatric outpatients with polypharmacy have a high risk of potentially inappropriate medication (PIM) use. Aim To identify differences in both prevalence and patterns of PIMs and drug-related problems (DRPs) in older outpatients who visited the tertiary hospitals (THs) and community health centers (CHCs) and analyze associated factors. Method A prospective cross-sectional study was conducted in five THs and five CHCs from September 2018 to November 2019 in Beijing, China. Data were collected from outpatients aged ≥ 65years with chronic diseases and polypharmacy. PIMs were evaluated using the 2015 and 2019 Beers Criteria and the Screening Tool of Older Persons' Prescriptions (STOPP) criteria. DRPs were classified using the Helper-Strand DRP Classification. The prevalence and types of PIMs and DRPs were compared, and relevant factors were analyzed. Results The prevalence of PIMs based on the 2015 Beers Criteria was higher in patients from the THs, while PIMs based on the 2019 Beers Criteria did not show a significant difference. PIM prevalence based on STOPP Criteria and DRPs was higher in patients from CHCs. Visiting CHCs was an independent factor of PIMs based on the 2015 Beers Criteria (OR 0.774, 95% CI 0.604-0.992) and the STOPP Criteria (OR 2.427, 95% CI 1.883-3.128), and DRPs (OR 3.612, 95% CI 2.682-4.865). Conclusion Differences in PIM and DRP might be due to the patients and settings. Specific measures to improve the appropriateness of medications in both settings should be used.

Evaluating Potentially Inappropriate Medications in Older Kidney Transplant Recipients.

Beers Criteria and the Screening Tool of Older Persons' Prescriptions (STOPP) Criteria/Screening Tool to Alert to Right Treatment Criteria are used to assess potentially inappropriate prescribing and medications, which could pose a harm to those of older age. The purpose of this study was to assess and compare the use of Beers and STOPP Criteria in older kidney transplant recipients. This was a dual-center, retrospective chart review from May 1, 2014, to March 1, 2018, including kidney transplant recipients 65 years and older. Those who underwent a dual transplant or had incomplete medical records were excluded. Outcomes included number of potentially inappropriate medications (PIMs) comparing Beers and STOPP Criteria on transplant admission, number of PIMs on admission compared with discharge, and readmissions within 3 months related to these medications. A total of 121 recipients were evaluated. On admission, 60 medications were listed on the STOPP Criteria compared with 106 medications on the Beers Criteria. When comparing PIMs on admission to discharge, there was a 38% decrease in the number of medications on discharge using the STOPP Criteria, whereas there was a 9% increase using the Beers Criteria. Older recipients were more likely to be on a medication listed in the Beers Criteria on admission and have a new medication listed in the Beers Criteria upon discharge compared with the STOPP Criteria.

Prevalence of Potentially Inappropriate Medications Among Older People in Qom, Iran Based on STOPP Criteria and Its Association With the Health-Related Quality of Life

Objectives: Aging is associated with an increased prevalence of chronic diseases and multidrug therapy, which increases the risk of drug side effects and changes in quality of life. With the increase of the world’s aging proportion, the quality and safety of prescribing drugs has become a global health concern. This study aims to determine the prevalence of Potentially Inappropriate Medications (PIMs) in the elderly in Qom, Iran according to STOPP (Screening Tool of Older Persons’ Prescriptions) criteria and its association with their Health-Related Quality of Life (HRQOL). Methods &amp; Materials: In this cross-sectional and descriptive-analytical study, participants were 783 older patients hospitalized in internal and surgical wards of selected hospitals affiliated to Qom University of Medical Sciences who were selected using a convenience sampling method. The instruments were a demographic/ health information form, Charlson Comorbidity Index (CCI), STOPP version 2, and the 15 D HRQOL questionnaire. The data were analyzed in SPSS v. 20 software using descriptive statistics and logistic regression analysis. Results: The Mean±SD number of medications used by the elderly was 7.21±3.16, and 79.57% of patients had multidrug use. The CCI score of 29.9% was 4. The prevalence of PIM was 46.10% and the most common category of PIM were Drugs that adversely affect those prone to falls (13.79%), Duplicate Drug Class (12.39%), Central Nervous System and Psychotropics (5.36%). The Mean±SD score of HRQOL was 0.85± 0.12. Logistic regression analysis results showed that HRQOL (95%CI: 0.030-0.307, OR= 0.096), multidrug use (95%CI: 4.780-14.966, OR=8.46), and CCI (95%CI: 1.36-3.17, OR=2.079) had significant association with PIM use by the elderly (P&lt;0.001). Conclusion: The use of PIM is a common health problem among the elderly and is associated with HRQOL, multidrug use, and CCI. Nurses should evaluate the elderly’s medication regimen to identify PIMs.

Prescription of Potentially Inappropriate Medication in Older Inpatients of an Internal Medicine Ward: Concordance and Overlap Among the EU(7)-PIM List and Beers and STOPP Criteria.

Background: Age-related comorbidities prone older adults to polypharmacy and to an increased risk of potentially inappropriate medication (PIM) use. This work aims to analyze the concordance and overlap among the EU(7)-PIM list, 2019 Beers criteria, and Screening Tool of Older Person’s Prescriptions (STOPP) version 2 criteria and also to analyze the prevalence of PIM.Methods: A retrospective cohort study was conducted on older inpatients of an internal medicine ward. Demographic, clinical, and pharmacological data were collected, during March 2020. After PIM identification by the EU(7)-PIM list, Beers criteria, and STOPP v2 criteria, the concordance and overlap between criteria were analyzed. A descriptive analysis was performed, and all the results with a p-value lower than 0.05 were considered statistically significant.Results: A total of 616 older patients were included in the study whose median age was 85 (Q1–Q3) (78–89) years. Most of the older patients were male (51.6%), and the median (Q1–Q3) number of days of hospitalization was 17 (13–22) days. According to the EU(7)-PIM list, Beers criteria, and STOPP criteria, 79.7, 92.0, and 76.5% of older adults, respectively, used at least one PIM. A poor concordance (<63.4%) among criteria was observed. An association between PIM and the number of prescribed medicines was found in all applied criteria. Moreover, an association between the number of PIMs and diagnoses of endocrine, nutritional, and metabolic diseases, mental, behavioral, and neurodevelopmental disorders, and circulatory system diseases and days of hospitalization was observed according to Beers criteria, and that with diseases of the circulatory system and musculoskeletal system and connective tissue was observed according to STOPP criteria.Conclusion: Despite the poor concordance between the EU(7)-PIM list, 2019 Beers, and STOPP v2 criteria, this work highlights the need for more studies in inpatients to develop strategies to facilitate the identification of PIM to decrease the high prevalence of PIM in hospitalized patients. The poor concordance among criteria also highlights the need to develop new tools adapting the existing criteria to medical ward inpatients.

Potentially inappropriate prescribing according to STOPP-2 criteria among elderly patients in an acute medical department: An observational study of prevalence, predictive factors

The aim of the study was to assess the prevalence and factors associated with potentially inappropriate medication use in elderly patients hospitalized in an acute medical unit. It is a prospective observational study carried out in the acute medical unit of Ibn Sina University Hospital located in Rabat, Morocco. The study sample consisted of all hospitalized patients aged ≥65years. Data collection was performed by a clinical pharmacist during an interview with the patient, at the multidisciplinary team meeting and from the patient's medical records. Medication use was assessed everyday from admission to discharge. The frequency of potentially inappropriate medication (PIM) was evaluated using The Screening Tool of Older Person's Prescriptions (STOPP) criteria version 2. The study involved 123 elderly inpatients aged 75±7 years old. In total, 55 patients (44.7%) used≥1 PIM. The highest prevalence of PIMs was in relation with concomitant use of two or more drugs with anticholinergic properties (16%). In adjusted multivariate analysis, the following parameters were independently associated with PIM use: length of stay at the acute medical unit (OR 1.12; 95% CI 1.00-1.20), and number of pre-admission drugs (OR 1.30; 95% CI 1.00-1.60). Half of the elderly population received at least one PIM identified by the STOPP criteria. Inadequacy of prescription was associated with the number of pre-admission drugs and the length of stay. Assessing medication during conciliation and enhanced drugs monitoring at discharge especially for patients with a longer stay can be an important strategy for minimizing PIM use.

Appropriateness of Medication Prescribing in Hospitalized Older Adults in a Tertiary Teaching Hospital in the Philippines: A Cross-Sectional Study.

BackgroundThe prescribing of potentially inappropriate medication (PIM) is a major health problem among older adults because of the high risk of adverse drug events. The number of older adults in the Philippines is increasing, and little is known about medication prescribing in this population.ObjectivesOur objective was to determine the prevalence of and factors associated with PIM in older patients admitted to a tertiary teaching hospital.MethodsThis was a cross-sectional study of patients aged ≥60 years admitted to a tertiary teaching hospital over a 3-month period. We used version 2 of the STOPP (Screening Tool of Older Persons’ Prescriptions) criteria to identify PIM prescribing.ResultsIncluded in this study were 328 older patients prescribed at least one medication; the median age was 65.5 years (interquartile range [IQR] 62–71), and 53.7% were women. The median number of medications prescribed was five (IQR 2–8). In total, 128 (39%) patients had at least one PIM, and the most common criterion was antimuscarinic/anticholinergic drug burden. PIM was significantly associated with polypharmacy (odds ratio 5.44; 95% confidence interval 1.54–19.20).ConclusionThe prevalence of PIM using STOPP version 2 was 39% in this sample of hospitalized older adults and was significantly associated with polypharmacy. There is a need to raise awareness about medication prescribing in the care and management of older patients.

Use of the STOPP and START criteria to address polypharmacy for elderly patients in University Hospital Lewisham Clinical Decisions Unit

Background: Polypharmacy and inappropriate prescribing are risk factors for adverse drug reactions, which commonly cause complications in older people. The STOPP (Screening Tool of Older Persons’ Prescriptions)/START (Screening Tool to Alert Doctors to Right Treatment) criteria are screening tools, which aim to improve prescribing in the elderly. Objectives: The aim was to improve prescribing, using the STOPP/START criteria, for patients aged 65 and above, who were admitted to the Clinical Decisions Unit at University Hospital Lewisham. We focused on the most common prescribing errors in clinical decision unit, an emergency medicine department. Methods: We reviewed all patients aged 65 and above admitted to the Clinical Decisions Unit in September. Data was collected from clinical documentation and archived drug charts. This pilot study of 114 patients revealed the most common prescribing errors, of which 8 were STOPP and 11 were START criteria. A plan–do–study–act methodology was implemented over 1 month, involving presentations, emails and posters. Prescribing patterns were then reviewed over 4 weeks in December in 111 patients. Results: Focusing on the 8 STOPP and 11 START criteria, there was a significant reduction in the proportion of patients with at least one STOPP error (17.5% to 9%, p = 0.04). However, the decrease in the percentage of patients with at least one START error was insignificant (24.6% to 20.7%, p = 0.24). Conclusion: By identifying problematic areas of prescribing and using targeted interventions, the proportion of STOPP errors made in clinical decision unit reduced significantly. This study highlights the prevalence of prescription errors in the clinical decision unit and the impact of using screening tools to reduce incorrect prescribing.

The impact of medication review with version 2 STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) criteria in a French nursing home: a 3-month follow-up study.

Background:Improving medication appropriateness is a priority of French national campaigns in nursing homes. A pilot study was conducted to evaluate the impact of a medication review in a French nursing home with a 3-month follow up.Method:A medication review was conducted in 2015 using version 2 STOPP and START criteria. The number and type of drugs meeting a STOPP that were reintroduced and the number and type of drug meeting a START that were stopped during follow up were measured. An expert committee adjudicated whether 3-month hospitalizations and deaths were related to medication review. The impact of medication review on the cost related to drug consumption was calculated for 3 months.Results:The 52 residents (age 84 ± 9 years, 83% female) fulfilled, on average, 2 ± 1.4 of the STOPP criteria and 0.7 ± 0.6 of the START criteria. A total of 101 drugs were stopped and 34 drugs were started. Five deaths occurred during follow up and were judged as not related to medication review. Five drugs stopped were reintroduced in five residents for a rebound effect or a symptom occurrence and one resident had stopped a START medication (aspirin) for a minor adverse drug reaction. At 3 months, a gain of 20.21 ± 31.34 euros per resident was observed.Conclusion:The medication review using version 2 STOPP and START criteria and involving the physician in charge seems useful for detecting and correcting inappropriate prescribing in a nursing home.

Assessing the overall medication use by elderly people in a Brazilian hospital using the start/stopp criteria version 2

To estimate the frequency of the use of medicines listed in the Screening Tool to Alert Doctors to the Right Treatment (START) and Screening Tool of Older Person’s Prescriptions (STOPP) criteria version 2 among the elderly. A cross-sectional study was conducted on elderly who were attended in medical clinic and cardiology sectors in a hospital in southern Brazil attended at a hospital from February through September 2016. A data-collection tool was used to obtain information on variables, such as demographic and clinical data, and medications used before and during the hospitalization period. The adequacy of the medicines taken was examined with regard to omission (START) or inappropriate use (STOPP). This study was approved by the Research Ethics Committee of the University of Southern Santa Catarina. A total of 307 subjects were included in the final sample. The mean age was 75.2 years (SD = 8; range 65-102). Of the total, 93.5% had had at least one potential prescribing omission (PPO) listed in the START criteria, whereas 95.4% used at least one medicine of the STOPP criteria. PPO was significantly associated with lower mean age (74.9 years, SD = 7.9 versus 79.0 years, SD = 8.8) among the elderly who did not have PPOs detected by the START criteria (p-value=0.03). Furthermore, PPO was associated with longer hospital stay (18 versus 9 days; p-value=0.03). This study revealed inadequate prescription affecting 99.3% of the participating patients. To the best of our knowledge, this was the first to use the START and STOPP criteria, version 2, in Brazil.

Identifying the prevalence of adverse drug events associated with potentially inappropriate medications using the Screening Tool of Older Persons’ Prescriptions criteria

Objectives The study's primary objective was to determine the prevalence of adverse drug events (ADEs) that could be identified using the Screening Tool of Older Persons’ Prescriptions (STOPP) criteria. Secondary objectives included characterizing and identifying the prevalence of potentially inappropriate medications (PIMs) and ADEs in the study population, classifying each of the identified ADE using the Naranjo scale, and identifying the time required to use this tool in the clinical setting. Methods The STOPP criteria were used to identify PIMs in elderly patients’ charts with a documented ADE. Patients who were found to have at least one PIM were reviewed to determine whether the documented ADE could be attributed to the PIM. Key findings A total of 290 PIMs were identified across three points of care: admission, hospital stay and discharge. The most prevalent types of PIMs were proton pump inhibitors (21%), benzodiazepines (14.1%) and duplicate drug class (7.9%). The most common ADEs that could be attributed to a PIM were incontinence associated with alpha-blockers (37.5%) and constipation associated with calcium-channel blockers (14.6%). The median time required for chart review on admission, hospital stay and discharge was 2, 2, and 1 minute, respectively. Conclusions The study suggests a large number of patients are affected by PIMs and secondary ADEs. With the short time that is needed to review patients’ medications, the STOPP criteria may be beneficial in reducing the number of ADEs associated with PIMs.

Potentially Inappropriate Medications in Elderly Haemodialysis Patients Using the STOPP Criteria.

BackgroundPolypharmacy is commonly applied to elderly haemodialysis patients for treating terminal renal failure and multiple co-morbidities. Potentially inappropriate medications (PIMs) in multidrug regimens in geriatric populations can be identified using specially designed screening tools.ObjectiveThe aims of this study were to estimate the prevalence of PIMs by applying the Screening Tool of Older Persons’ Prescriptions (STOPP) criteria and the Beers criteria to elderly haemodialysis patients and to assess the association of some risk factors with the presence of PIMs.MethodsFifty-one elderly haemodialysis patients participated; their median age was 74 (range 65–89) years, and 77 % of them were male. Demographic data, co-morbidity and medication lists were collected from the electronic medical records of the patients. The STOPP criteria were applied by two physicians independently to identify PIMs. The association of some risk factors with PIMs were assessed using Fisher’s exact test.ResultsThe patients used a median of 13 (range 7–21) medications per day. The overall prevalence of PIMs using the STOPP criteria was 63 %, and using the Beers criteria was 43 %. The most prevalent PIMs were proton-pump inhibitors. Benzodiazepines and first-generation antihistamines were related to side effects such as falls in the previous 3 months, and calcium-channel blockers were associated with chronic constipation. The number of PIMs was not significantly associated with number of medications, age, sex and co-morbidity.ConclusionsThe STOPP criteria revealed a high prevalence of PIMs in a population of elderly patients receiving haemodialysis.

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.

CP-021 Incorporation of the stopp criteria into clinical pharmacy practice

<h3>Background</h3> Hospital pharmacists providing a clinical pharmacy service are well placed to apply the Screening Tool of Older Persons’ Prescriptions (STOPP) criteria to elderly inpatients to identify potentially inappropriate prescribing. <h3>Purpose</h3> To incorporate the STOPP criteria into clinical pharmacy practice; to ascertain what proportion of clinical pharmacists’ recommendations based on the STOPP criteria were implemented in practice; and to explore doctors’ reasons for non-implementation. <h3>Material and methods</h3> Pharmacists applied the entire STOPP criteria to a random selection of inpatients. On identification of (a) potentially inappropriate medicine (s) (PIM(s)), the pharmacist documented their recommendation (s) in the patient’s medical records and contacted the patient’s doctor. Follow up after 3–4 working days determined if the recommendations had been implemented. For recommendations not accepted, a semi-structured telephone interview was conducted with doctors to explore the reason (s) for non-implementation. <h3>Results</h3> 140 patients were included in the study with a median age of 79 years. The median number of regular medicines prescribed was 8. Pharmacists identified 50 PIMs related to 44 patients; however, on review of the patient’s medical notes, pharmacists deemed 22 of these PIMs appropriate. Pharmacists made a written and verbal recommendation involving 28 STOPP PIMs in 25 patients (17.8%). Doctors implemented 16 (57%) out of 28 recommendations, 7 PIMs (25%) were not accepted and 5 PIMs (18%) were lost to follow up. 7 Doctors were contacted to participate in a semi-structured telephone interview in relation to 7 PIMs prescribed (All related to proton pump inhibitors). The average time taken to apply the STOPP criteria Was 9.97 min. <h3>Conclusion</h3> Incorporation of the STOPP criteria into clinical pharmacy practice is an effective method of identifying PIMs in the elderly population. Doctors are receptive to clinical pharmacists’ interventions with the exception of proton pump inhibitors. <h3>References and/or Acknowledgements</h3> No conflict of interest.

An Educational Intervention on Drug Use in Nursing Homes Improves Health Outcomes Resource Utilization and Reduces Inappropriate Drug Prescription

ObjectiveInappropriate drug prescription is a common problem in people living in nursing homes and is linked to adverse health outcomes. This study assessed the effect of an educational intervention directed to nursing home physicians in reducing inappropriate prescription and improving health outcomes and resource utilization. DesignProspective, randomized, multicenter study. SettingA private organization of nursing homes in Spain. ParticipantsSixty nursing home physicians caring for approximately 3900 nursing home residents in 37 centers were randomized to receive an educational intervention (30) or as a control group (30). Intervention10 hours educational program, followed by on demand support by phone. Outcome MeasurementsOutcomes were assessed in 1018 randomly selected nursing home residents. Appropriateness of drug use [measured by the Screening Tool of Older Persons Prescriptions (STOPP) and Screening Tool to Alert Doctors to Right Treatment (START) criteria], incidence of selected geriatric syndromes (falls, delirium) and health resource utilization (visits to physicians and nursing homes, visits to the emergency room, days of hospitalization) were recorded for 3 months before the intervention started and 3 months after the intervention finished. ResultsO total of 716 residents finished the study (344 cared for by the intervention group physicians, 372 cared for by control physicians). Mean age was 84.4 ± 12.7 years; 73% were women. The mean number of inappropriate drugs (STOPP criteria) was higher at the end of the study in the control than in the intervention group (1.29 ± 1.56 vs 0.81 ± 1.13), as was the number of residents on 6 or more drugs (76.5% vs.67.0%), using antipsychotics (9.1% vs 3.2%) or duplicate medications (32.5% vs 9.2%). The number of fallers increased in the control group (from 19.3% to 28%) and did not significantly change in the intervention group (from 25.3% to 23.9%); the number of residents with delirium increased in the control group (from 3.8% to 9.1%) and decreased in the intervention group (from 6.1% to 3.2%). The number of visits to a physician did not change in the control group (−0.22, P = .3) but were significantly reduced in the intervention group (−0.76, P = .01), the same happened with the number of visits to a nurse (−0.38, P = .4 in controls, −1.43 in the intervention group, P < .001). Visits to the emergency room and days in hospital significantly increased in the control group (+0.12 and +0.38) but were unchanged in the intervention group (+0.03 and +0.01). ConclusionsAn educational intervention on drug use is feasible in nursing home physicians and improves the use of inappropriate drugs, use of antipsychotics, and drug duplications in their residents. It may also improve the risk of delirium and falls, and reduce the use of health care resources.