STOPP-START Criteria Research Articles

The impact of patient-facility language discordance on potentially inappropriate prescribing of antipsychotics in long-term care home in Ontario, Canada: a retrospective population health cohort study

BackgroundAppropriate use of medication is a key indicator of the quality of care provided in long-term care (LTC). The objective of this study was to determine whether resident-facility language concordance/discordance is associated with the odds of potentially inappropriate prescribing of antipsychotics (PIP-AP) in LTC.MethodsWe conducted a population-based, retrospective cohort study of LTC residents in Ontario, Canada from 2010 to 2019. We obtained resident language from standardized resident assessments, and derived facility language by determining the proportion of residents belonging to each linguistic group within individual LTC homes. Using linked administrative databases, we identified all instances of PIP-AP during a 1-year follow-up period. PIP-AP was defined using the STOPP-START criteria, which have previously been shown to predict adverse clinical events such as emergency department (ED) visits and hospitalizations. The association between linguistic factors and PIP-AP was assessed using adjusted multivariable logistic regression analysis.ResultsWe identified 198,729 LTC residents consisting of 162,814 Anglophones (81.9%), 6,230 Francophones (3.1%), and 29,685 Allophones (14.9%). The odds of PIP-AP of were higher for both Francophones (aOR 1.15, 95% CI 1.08–1.23) and Allophones (aOR 1.11, 95% CI 1.08–1.15) when compared to Anglophones. When compared to English LTC homes, French LTC homes had greater odds of PIP-AP (aOR 1.12, 95% CI 1.05–1.20), while Allophone homes had lower odds of PIP-AP (aOR 0.82, 95% CI 0.77–0.86). Residents living in language-discordant LTC homes had higher odds of PIP-AP when compared to LTC residents living in language-concordant LTC homes (aOR 1.07, 95% CI 1.04–1.10).ConclusionThis study identified linguistic factors related to the odds of PIP-AP in LTC, suggesting that the linguistic environment may have an impact on the quality of care provided to residents.

The management of polypharmacy in people living with HIV.

Antiretroviral therapy (ART) has modified the prognosis of HIV which has evolved into a chronic condition. People living with HIV (PLWH) are living longer presenting an increased number of comorbidities leading to polypharmacy. Literature on the prevalence, associated factors, drug-drug interactions (DDIs), effects on ART-outcomes, geriatric conditions, and nutritional status together with health-interventions aimed to reduce it is presented in this review. A literature search was conducted on the MEDLINE database for all relevant English- and Spanish-language studies since 2006. Studies providing data of interest were identified and ordered in groups: (i) prevalence and associated factors (n = 37), (ii) DDIs (n = 19), (iii) Effects on ART-outcomes (n = 12), (iv) Effects on health conditions (n = 13), and (V) Health-interventions to assess and/or reduce it (n = 9). Polypharmacy occurs in 9-91% of PLWH (2.6-19.5% affected by severe polypharmacy). Main factors associated with polypharmacy are older age, a higher number of comorbidities, frailty, deteriorated renal function, and previous hospitalizations. DDIs were present in 19.15-84% of cases (1.3-12.2% for the most severe types). Mainly involved non-ART drugs were antihypertensives, statins, antithrombotic agents, corticosteroids, divalent cations, and antiacids. Polypharmacy can affect ART selection, adherence, and outcomes and has been related to some geriatric conditions such as falls, frailty, and poor nutritional status. Potentially prescribing issues are present in up to 87.9% of cases according to the STOPP-START and Beers criteria and some pharmacist-led interventions have been shown to reduce it. Considering these findings, polypharmacy should be considered a clinical concern in this population and treatment-optimization programs are needed to reduce its burden.

STOPP-START Criteria Used to Identify the Elderly Population Prone to Potentially Inadequate Prescribing in a Colombian Cohort.

Elderly people have multiple comorbidities that often require treatment with multiple medications. Having strategies to lessen the risks associated with pharmacological interactions and potentially inadequate prescribing (PIP) is of major importance. The STOPP- START criteria are useful in identifying PIP along with other tools, such as LASA (look alike/sound alike) drugs and high-risk medications (HRM). We aimed to clinically and sociodemographically characterize the population with PIP according to the STOPP-START criteria in hospitalized elderly patients over 6 months in a third-level hospital in Colombia, South America. We also aimed to calculate the prevalence of PIP, LASA drugs and HRM and to identify other problems related with medication. Finally, we proposed an algorithm for the identification of PIP in this population. This was a descriptive, cross-sectional study in hospitalized patients older than 60 years during the first semester of 2021 to identify PIP according to STOPP- START criteria. An analysis of clinical and sociodemographic variables was conducted, as well as the construction of an algorithm to identify PIP in the elderly in a semiautomated way. Data were collected and analyzed using the software SPSS 2021, using descriptive statistics and measures of central tendency. The prevalence of PIP in the study population was 25%. Furthermore, 60% of patients had one problem related to medication, and 27% used at least one LASA drug or HRM. This study allows one to characterize, for the first time, the Colombian population prone to PIP, as well as the construction of an algorithm that identifies PIP in a semiautomated way.

Chronic benzodiazepine usage among older people: prevalence, indications, and treatment modifications in patients admitted to an acute geriatric unit.

To investigate the prevalence and indications of benzodiazepines (BZD) usage among patients admitted to an acute geriatric unit and assess changes in prescriptions. BZD indications were documented reviewing clinical records, with appropriateness assessed based on the STOPP-START criteria. Changes in BZD prescriptions were recorded at discharge and 3 months later. Among the 366 patients included (mean age: 92.8years, 68% females), 91 (24.9%) were on BZD upon admission, being inappropriate in 93.4%. At discharge,BZD discontinuation was observed in 40.7% and dose reduction initiated in 57.4%. Among patients discharged without prescriptions, 10.8% resumed their use at 3months. Of those discharged with BZD tapering, 74.1% were still on them 3months later. The majority of patients employing BZD lacked a medical indication. Admission to a geriatric ward resulted in successful discontinuation or dose reduction for most patients but was not maintained in the outpatient setting.

Prevalence of adverse drug events in emergency departments. FARM-URG multi-center project

ObjectiveAdverse drug events are a well-known cause of emergency department admissions. FARM-URG is a project promoted by the REDFASTER working group of the Spanish Society of Hospital Pharmacy. Its aim is to evaluate these adverse events through regular prevalence measurements. The present study shows the results of the first observations. The goal was to determine the prevalence of adverse drug events with respect to the total number of patients treated in emergency departments and carry out a description of the different events identified. MethodThis is a multicenter cross-sectional study carried out in the emergency room of 13 Spanish hospitals. The identification and registration of patients were obtained from the emergency department patient census at the time of the first prevalence measurement (16 June 2020). The REDCap® platform was used for patient registration. ResultsThe 2020 FARM-URG registry, which included 13 hospitals, evaluated 772 patients, of whom 57 (7.4%) consulted for adverse drug events. Antithrombotic drugs were responsible for most of these episodes, acenocoumarol being the main drug involved (22.8%). Nine (15.8%) adverse drug events were caused by inappropriate drug prescriptions according to the STOPP-START criteria. Nineteen (33.0%) patients returned to the emergency service within 30 days from discharge. ConclusionsAdverse drug events are a frequent cause of emergency department visits and are commonly associated with a significant percentage of re-visits. The FARM-URG project has been created with the purpose of obtaining dynamic and updated information on such events.

The Evaluation of the Prevalence of Improper Medication Use in Patients Age of 65 and over in Internal Diseases and Neurology Intensive Care Units in Terms of Stopp-Start Criteria

The Evaluation of the Prevalence of Improper Medication Use in Patients Age of 65 and over in Internal Diseases and Neurology Intensive Care Units in Terms of Stopp-Start Criteria

Clinical assessment and management of patients with multimorbidity.

Internal medicine specialists, also known as general internal medicine specialists are specialist physicians trained to manage particularly complex or multisystem disease conditions that single-organ-disease specialists may not be trained to deal with. The management of multimorbidity, however, is often complex, and requires specific clinical skills and corresponding experience in appropriate diagnostic and therapeutic procedures. Multimorbidity is associated with a decline in many aspects of health and in consequence with an increase in hospital admissions, polypharmacy, and use of health care and social resouces. When prescribing medicine to patients with multimorbidity, all the risks and benefits, as well as possible interactions should be carefully considered. The prescription appropriateness can be assessed by validated tools like STOPP-START criteria. Beneficial part of good prescribing is deprescribing - planned and supervised process of dose reduction or withdrawal of medications that are no longer needed in the circumstances of the patient.

Prescripción inapropiada de medicamentos en personas mayores

Drugs are widely used to treat acute and chronic conditions in older people. However, the incidence of adverse drug reactions increases with age and are a frequent cause of hospital admission, especially in patients with multimorbidity and polypharmacy. Many of these adverse drug reactions could potentially be prevented. A prescription is considered to be potentially inappropriate in an older person if it carries a significant risk of producing an adverse drug reaction, especially when a safer alternative is available. In recent years, many instruments have been developed to help detecting potentially inappropriate prescriptions, most of them explicit lists of drugs that should not be used or cannot be used in the presence of certain conditions. The most widely used are the Beers-AGS criteria and the STOPP-START criteria. A systematic use of such instruments has been shown to improve not only the quality of prescriptions, but also several health outcomes in older multimorbid patients. Research is growing on the new concept of deprescription, described as the process of withdrawing inappropriate drugs, supervised by a health care professional, with the intention of reducing polypharmacy, improving outcomes and limiting iatrogenia. Prescriptors should become familiar with the different tools available to improve prescription quality and reduce drug related risks in older complex patients.

Поліфармація: визначення, ризики, менеджмент

Проведено пошук у базах даних Scopus, Web of Science, MedLine, The Cochrane Library. Термін «поліфармація» на відміну від терміна «поліпрагмазія» не завжди має негативний відтінок, і його часто застосовують для позначення одночасного використання пацієнтом п’яти та більше лікарських засобів, а інтенсивною вважають поліфармацію у випадках, коли пацієнт одночасно вживає 10 і більше лікарських засобів. Однією з основних причин поліфармації є поліморбідність. Поліфармацію також можуть спричиняти тяжкий стан пацієнта, самолікування і невідповідні рекомендації, деякі демографічні фактори (вік, стать, рівень освіти), рівень розвитку системи охорони здоров’я. Поліфармація може бути відповідною (обґрунтованою), коли призначення великої кількості лікарських засобів виправдано, та невідповідною (проблемною), коли кількість призначених лікарських засобів неправильна та незбалансована. Проблемна поліфармація є проявом поліпрагмазії, при цьому кілька лікарських засобів призначають неналежним чином, що не дозволяє реалізувати передбачувану перевагу даних лікарських засобів, і ризик заподіяння шкоди від лікування перевищує користь внаслідок взаємодії лікарських засобів, виникнення побічних реакцій, збільшення економічного тягаря лікування. Особливо небезпечною є проблемна поліфармація для пацієнтів у тяжкому стані. Менеджмент проблемної поліфармації повинен базуватися на переведенні її у збалансовану форму. Обґрунтовується комбінація лікарських засобів, що дозволяє лікувати пацієнта ефективно, безпечно й економічно доцільно через попередження їх взаємодії та побічних ефектів. Як терапевтичне втручання може використовуватися відміна певних лікарських засобів, яку в кожного конкретного пацієнта потрібно здійснювати через оцінку переваг і ризиків. Для профілактики та корекції проблемної поліфармації в осіб похилого віку запропоновані критерії Beers, інструменти ARMOR, STOPP-START.

Impact of a pharmacist and geriatrician medication review on drug-related problems in older outpatients with cancer

ObjectivesOlder patients with cancer have increased risk for comorbidity, polypharmacy (PP) and drug related problems (DRP). The aim of this study was to assess the effect of a clinical pharmacist and geriatrician medication review (MR) among older outpatients with cancer to optimize management of comorbidities during comprehensive geriatric assessment (CGA). Material and MethodsWe conducted a single-center prospective study among older outpatients with cancer (≥75 years). A pharmacist consultation was added into CGA process. The clinical pharmacist detected and assessed PP and DRP such as potentially inappropriate medications (PIM) according to the Laroche French list and STOPP criteria, START criteria and adverse drug events (ADE) risk. After a multidisciplinary MR, the proposals for prescription modification were sent to general practitioners (GPs). ResultsFifty-one consenting patients were recruited between May 2016 and March 2017, with a median age of 83 years. Prevalence of PP was 80.4%. 165 DRP were detected among 86% patients (median number of DRP = 3.0): 19.4% were misuse, 43.6% underuse, and 37.0% overuse. A significant decrease was observed in prevalence of PIM use (Laroche: 31.4% versus 5.9%, p = 0.002), START criteria (66.7% to 5.9%; P < 0.001) and ADE score (4.0 before MR versus 2.0 after, p = 0.023). A trend was observed for a lower number of medications (10.0 versus 8.0, p = 0.092) and on STOPP criteria prevalence (56.9% versus 31.4%, p = 0.12). ConclusionA clinical pharmacist and a geriatrician MR is effective to detect and reduce DRP in older outpatients with cancer.

Assessing Potentially Inappropriate Medications in Hospitalized Geriatric Patients in 2 Hospital in Jakarta using STOPP START Criteria

Geriatric patients have more comorbidities and often receive polypharmacy prescriptions. The prevalence of inappropriate drug use in geriatric patients is in the range of 11.5% - 62.5%. The consequence of polypharmacy is Adverse Drug Reactions (ADR). An effort to reduce the occurrence of medication errors in geriatric patients is the STOPP and START criteria. This study aimed to identify PIMs (Potentially Inappropriate Medications) and PPO (Potentially Prescribing Omission) in geriatric patients according to STOPP / START criteria at Gatot Soebroto Army Hospital and the Jakarta Cempaka Putih Islamic Hospital. This study used a descriptive-analytical method with a cross-sectional design and a prospective data collection method based on analysis of medical records, inpatient installation, and pharmacy installation at Gatot Soebroto Army Hospital in Jakarta on October 2017 and Jakarta Cempaka Putih Islamic Hospital in January 2019. The tool used to collect data in this research was the STOPP START toolkit supporting medication review version 1 2016. The results show that of 85 hospitalized geriatric patients at Gatot Soebroto Army Hospital with the use of 579 drugs, PIMs were present in 8.24% of patients and the prevalence of PPO was 5.88%. Meanwhile, out of 124 hospitalized geriatric patients in Jakarta Cempaka Putih Islamic Hospital with the use of 945 drugs, PIMs were present in 35.48% of patients and the prevalence of PPO was 6.45%. Polypharmacy found to be an independent predictor for PIMs incident.

Adecuación de la prescripción farmacológica durante el ingreso en un centro sociosanitario: experiencia clínica con los criterios STOPP/START

Background and objectivesThe elderly patient is particularly vulnerable to potentially inappropriate prescription (PIP) due to physiological reasons, comorbidity, polypharmacy or the different pharmacokinetics/pharmacodynamics of drugs. The aim of this study was to determine the prevalence of PIP according to the STOPP-START criteria in patients over 65 years admitted into a geriatric hospital, as well as to appraise its acceptance by geriatricians. Material and methodsRetrospective observational study. Patients older than 65 years consecutively admitted to medium/long-stay units were included. The study information was obtained by reviewing the clinical record of the patients. The PIP according to the STOPP-START criteria were assessed by the geriatrician, who decided whether or not to modify the medication and recorded the reasons. Results247 patients were included, mean age was 82.6 years (SD 7.3), 72.1% of patients were female and a median of 7 drugs (25-75 percentile: 4-9). 78.9% (95%CI: 73.3-83.9) of patients had at least one PIP STOPP-START at admission, 44.9% (95%CI: 38.6-51.4) PIP-STOPP and 59.5% (95%CI: 53.1-65.7) PIP-START. At hospital discharge, the prevalence of PIP-STOPP-START was 46.2% (95%CI: 39.8-52.6), 19.0% (95%CI: 14.3-24.5) of PIP-STOPP and 34.4% (95%CI: 28.5-40.7) PIP-START. ConclusionsThe comprehensive geriatric assessment and the use of the STOPP-START criteria can significantly reduce the prevalence of PIP among patients admitted to a geriatric hospital. Nevertheless, issues such as frailty, multimorbidity and functional goals would be taken into account in the appropriateness of the prescription.

Atención farmacéutica de adultos mayores. Aplicación de los criterios STOPP-START

IntroductionDrug-related problems can be caused by potentially inappropriate prescribing (PIP), one of the most used tools for its identification are the STOPP (Older Persons’ potentially inappropriate Prescriptions) - START (Screening Tool to Alert doctors to Right Treatment) criteria. The objective of this study is to determine PIP in older adults who receive pharmaceutical care in the Pharmacotherapy Optimization Unit (POU)-Rosario. Materials and methodsPharmacoepidemiological observational study, which evaluates the quality of medication use. Workplace: POU-Rosario. Population under study: adults over 60 years of age, who received pharmacotherapy follow-up during the period March 2017 to February 2018. PIPs were identified using the STOPP-START criteria, 2014 version; selecting the most appropriate criteria to assess outpatient pharmacotherapy. Prevalence of PIP and amount of PIP per active principle were estimated. Results50 patients older than 60 years received pharmacotherapy follow-up in the POU; 47 patients (94.0%) had at least one PIP corresponding to a STOPP criterion; 17 STOPP criteria were found among the 41 initially selected, leading to 145 PIPs identified. And 7 START criteria among the 11 initially selected, leading to 50 PIPs identified. Medications with a higher amount of PIPs: benzodiazepines and proton pump inhibitors. ConclusionsThis study allowed the identification of a high prevalence of PIP. The data obtained show the usefulness of these criteria. The STOPP-START criteria have been included to support decision making during pharmacotherapy follow-up to propose pharmaceutical interventions, in order to enhance pharmacotherapy. These activities contribute to patient safety, a dimension of health quality.

\u2018Modified STOPP-START criteria for Sri Lanka\u2019; translating to a resource limited healthcare setting by Delphi consensus

Background‘Screening tool of older people’s prescriptions (STOPP) and screening tool to alert to right treatment (START)’ criteria is a useful tool to assess the appropriateness of medicines among older adults. However, the original STOPP/START criteria developed in the West, may not be directly applicable to resource limited healthcare settings like Sri Lanka. Hence, we aimed to modify STOPP/START criteria (Version 2) to suit Sri Lanka.MethodTwo investigators (a clinical pharmacologist and a pharmacist) reviewed and flagged criteria that were unfeasible to Sri Lanka based on their previous research experiences on using STOPP/START version 1. A Delphi consensus methodology was conducted among six experts, including geriatricians, clinical pharmacologists, physicians and a pharmacist, to review and assess each criterion (including the ones flagged by the researchers) for suitability to Sri Lanka.ResultsTwo Delphi validation rounds were conducted. A final meeting was held with the participation of all experts to resolve disagreements and to establish 100% consensus. The expert panel agreed on a list of 105 criteria, including 70 STOPP and 35 START criteria, indicating an 8% reduction in criteria compared to the original version. Modifications included complete removal (n = 11), re-wording (n = 25), splitting (n = 1) of original criteria and adding a new criterion (n = 1). Main reasons for modifications were unavailability of some medicines in the country, unavailability or inaccessibility of specific clinical information required for assessment of criteria, and adherence to treatment guidelines commonly used in the country.ConclusionA list of ‘Modified STOPP/START criteria for Sri Lanka’ was developed. These criteria are currently being validated through a multi-centre study.

Impact of an intervention program to improve potentially inappropriate prescription in hospitalized elderly patients

Introduction and objectivesPotentially inappropriate prescription (PIP) is common in elderly people. It has become a global public health problem due to its association with adverse drug effects (ADE), increased morbidity and mortality, emergency care visits and resource use. The main aim of this study was to determine whether the use of a notification program of PIP in elderly patients admitted in the hospital led to a reduction of their prescription. MethodA quasi-experimental before–after study was conducted. PIP were identified by using Beers (2012 update) and STOPP-START criteria (2008 version). An individualized report on PPI was prepared and the effect of this intervention was evaluated. Results174 patients were included who presented 284 PIP. 54% (153) of the recommendations were accepted. Barthel index was the only variable that proved to contribute to the presence of PIP modifications. The patients whose PIP drugs were modified were significantly more dependent (p=.005), presented cognitive impairment (p=.001) and were more institutionalized (p=.039) than those without any modifications. There were fewer readmissions, emergency care visits and mortality within six months after intervention comparing patients with and without PIP modifications, but without significant differences. 32 ADE were detected, 29 related with PIP drugs. Adverse events were significantly associated with PIP drugs, versus other medications (p<.001), odds ratio 242.5 (95% CI: 56.9–1023.6). ConclusionsReview of medication in elderly patients, along with the use of tools that help in the identification of dangerous drugs, entail a reduction of inadequate prescription and significantly contribute to the continuous improvement of chronic medication in elders.

Inappropriate prescribing defined by STOPP and START criteria and its association with adverse drug events among hospitalized older patients: A multicentre, prospective study.

ObjectivesTo provide baseline information on inappropriate prescribing (IP), and to evaluate whether potentially inappropriate medications (PIMs), as defined by STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) criteria, were associated with preventable adverse drug events (ADEs) and/or hospitalization.MethodsWe prospectively studied older patients (n = 301) admitted to three urban, public-funded hospitals. We scrutinized their medical records and used STOPP-START (Screening Tool to Alert Prescribers to Right Treatment) criteria to determine PIM and potential prescribing omissions (PPO) respectively- together these constitute IP. Prescriptions with PIM(s) were subjected to a pharmacist medication review, aimed at detecting cases of ADE(s). The vetted cases were further assessed by an expert consensus panel to ascertain: i) causality between the ADE and hospitalization, using, the World Health Organization Uppsala Monitoring Centre criteria, and, ii) whether the ADEs were avoidable (using Hallas criteria). Finally, percentages of PIM-associated ADEs that were both preventable and linked to hospitalization were calculated.ResultsIP prevalence was 58.5% (n = 176). A majority (49.5%, n = 150) had moderate to severe degree of comorbidities (Charlson Comorbidity Index score ≥ 3). Median age was 72 years. Median number of medications was 6 and 30.9% (n = 93) had ≥8 medications. PIM prevalence was 34.9% (117 PIMs, n = 105) and PPO 37.9% (191 PPOs, n = 114). Most PIMs and PPOs involved overuse of aspirin and underuse of both antiplatelets and statins respectively. With every increase in the number of medications prescribed, the likelihood of PIM occurrence increased by 20%, i.e.1.2 fold (OR 1.20, 95% CI: 1.1–1.3). Among the 105 patients with PIMs, 33 ADEs (n = 33); 31 ADEs (n = 31) considered “causal” or “contributory” to hospitalization; 27 ADEs (n = 27) deemed “avoidable” or “potentially avoidable”; and 25 PIM-associated ADEs, preventable, and that induced hospitalization (n = 25), were identified: these equated to prevalence of 31.4%, 29.5%, 25.7%, and 23.8% respectively. The most common ADEs were masked hypoglycemia and gastrointestinal bleed. With every additional PIM prescribed, the odds for ADE occurrence increased by 12 folds (OR 11.8, 95% CI 5.20–25.3).ConclusionThe majority of the older patients who were admitted to secondary care for acute illnesses were potentially exposed to IP. Approximately a quarter of the patients were prescribed with PIMs, which were plausibly linked with preventable ADEs that directly caused or contributed to hospitalization.

Impacto de un programa de intervención destinado a la mejora de la prescripción potencialmente inapropiada en pacientes ancianos hospitalizados

Introduction and objectivesPotentially inappropriate prescription (PIP) is common in elderly people. It has become a global public health problem due to its association with adverse drug effects (ADE), increased morbidity and mortality, emergency care visits and resource use. The main aim of this study was to determine whether the use of a notification program of PIP in elderly patients admitted in the hospital led to a reduction of their prescription. MethodA quasi-experimental before-after study was conducted. PIP were identified by using Beers (2012 update) and STOPP-START criteria (2008 version). An individualized report on PPI was prepared and the effect of this intervention was evaluated. Results174 patients were included who presented 284 PIP. 54% (153) of the recommendations were accepted. Barthel index was the only variable that proved to contribute to the presence of PIP modifications. The patients whose PIP drugs were modified were significantly more dependent (p=0.005), presented cognitive impairment (p=0.001) and were more institutionalized (p=0.039) than those without any modifications. There were fewer readmissions, emergency care visits and mortality within six months after intervention comparing patients with and without PIP modifications, but without significant differences. 32 ADE were detected, 29 related with PIP drugs. Adverse events were significantly associated with PIP drugs, versus other medications (p<0.001), odds ratio 242.5 (CI95%: 56.9-1023.6). ConclusionsReview of medication in elderly patients, along with the use of tools that help in the identification of dangerous drugs, entail a reduction of inadequate prescription and significantly contribute to the continuous improvement of chronic medication in elders.

Evaluación de la actualización de los criterios STOPP-START en atención primaria

IntroductionThe aim of this study is to determine the rate of potentially inappropriate prescriptions (PIP) in people older than 64 years of age in Avilés, Asturias, Spain. Materials and methodsA descriptive cross-sectional study was conducted in six Health Care Centres. A sample of 400 people was selected, obtained by a random sampling proportional to the population registered in each Health Centre. A review was made of the computerised clinical records, and the STOPP-START (version 2014 with 114 items) criteria were applied to evaluate the PIP. ResultsThe study contained 378 (95.5%) patients with a mean age of 75.4 (SD: 7.4) and of which 57.7% were women. Almost all (94.2%: 95% CI; 91.7-96.7) met some PIP criteria. Taking only the STOPP criteria into consideration, 52.4% (95%CI: 47.2-57.6) met at least one breach, and in the START criteria a 90.5% (95%CI; 87.4-93.6), which was reduced to 40.5% (95%CI; 36.4-45.6) if criteria on vaccination were removed. In the STOPP criteria, the most frequent PIP was taking benzodiazepines followed by the use of medication without indications based on the evidence; in the START, the criteria was the anti-pneumococcus vaccination, and the lack of taking vitamin D supplements and calcium in osteoporosis. ConclusionsThere were high levels of PIP, very superior to the previous version, especially for the START criteria. There is a high level of PIP related to the use of benzodiazepines and the use of medication without any clinic evidence. The STOPP-START criteria are useful in Primary Care to assess the PIP.

Implementing a screening tool to improve prescribing in hospitalized older patients: a pilot study

Background The use of STOPP-START criteria during hospitalization reduced inappropriate medications in randomized controlled trials. Objective To evaluate whether the implementation of a screening tool (short version of STOPP-START criteria) in routine geriatric practice reduces potentially inappropriate medications (PIM) and potential prescribing omissions (PPO) at discharge. Methods We conducted a retrospective interrupted time series analysis. Four periods were selected between February and September 2013: (1) baseline situation; (2) screening tool made available to physicians; (3) 3months later; (4) weekly meetings with junior doctors and a clinical pharmacist to review treatments according to the tool. The primary outcome was the proportion of patients with prescribing improvement from admission to discharge. Results We included 120 patients (median age 85years). The prevalence of PIMs and PPOs on admission was 56% (67/120) and 51% (61/120) respectively. Hospitalization improved prescribing appropriateness in 49% of patients with PIMs (33/67) and 39% of patients with PPOs (24/61). The use of the screening tool by way of multidisciplinary meetings was a predictor of PIMs reduction at discharge. Conclusions The sole distribution of a screening tool in a geriatric unit did not reduce PIMs and PPOs. Multidisciplinary meetings to review treatments should be encouraged.

Impacto de los resultados a medio plazo de la prescripción inadecuada en los pacientes ancianos dados de alta desde una unidad de corta estancia

ObjectiveTo study the association between the potential inappropriate prescriptions (PIP) and the 30 and 180-day adverse event rate after discharge from a Short Stay Unit (SSU). MethodologyA retrospective cohort observational study was conducted on patients aged ≥75years discharged from an SSU from February to April, 2014. STOPP-START criteria version2 was used. The main outcome was 30 and 180-day adverse event rate after being discharged. ResultsA total of 179 patients, with a mean age of 84 (SD5) years were included. The presence of ≥1PIP after being discharged was not associated with a 30 and 180-day composite adverse event. Patients with ≥1PIP related to a cerebro-cardiovascular process were at higher risk of an adverse event at 30 days after discharge (adjusted OR, 2.1; 95%CI: 1.0-3.2; P=.045), those with ≥1PIP related to neuropsychiatric process and risk of fall were at higher risk of increased 30-day functional impairment (adjusted OR, 6.3; 95%CI: 1.7-22.5; P=.005), and those with ≥1PIP related to omission of cardiovascular system were at higher risk of 180-day hospital readmission (adjusted OR, 3.6; 95%CI: 1.5-8.3; P=.003). ConclusionsThe presence of adverse events in older patients discharged from SSU may be associated with PIP, identified by STOPP-START criteria, and more specifically with drugs related to cardiovascular, neuropsychiatric disorders, and falls.