Potentially inappropriate prescribing in institutionalised older patients in Spain: the STOPP-START criteria compared with the Beers criteria

Abstract Objectives The objectives of the present analyses are to estimate the frequency of potentially inappropriate prescribing (PIP) at admission according to STOPP/START criteria version 2 in older patients hospitalised due to chronic disease exacerbation as well as to identify risk factors associated to the most frequent active principles as potentially inappropriate medications (PIMs). Methods A multicentre, prospective cohort study including older patients (≥65) hospitalized due to chronic disease exacerbation at the internal medicine or geriatric services of 5 hospitals in Spain between September 2016 and December 2018 was conducted. Demographic and clinical data was collected, and a medication review process using STOPP/START criteria version 2 was performed, considering both PIMs and potential prescribing omissions (PPOs). Primary outcome was defined as the presence of any most frequent principles as PIMs, and secondary outcomes were the frequency of any PIM and PPO. Descriptive and bivariate analyses were conducted on all outcomes and multilevel logistic regression analysis, stratified by participating centre, was performed on the primary outcome. Results A total of 740 patients were included (mean age 84.1, 53.2% females), 93.8% of them presenting polypharmacy, with a median of 10 chronic prescriptions. Among all, 603 (81.5%) patients presented at least one PIP, 542 (73.2%) any PIM and 263 (35.5%) any PPO. Drugs prescribed without an evidence-based clinical indication were the most frequent PIM (33.8% of patients); vitamin D supplement in older people who are housebound or experiencing falls or with osteopenia was the most frequent PPO (10.3%). The most frequent active principles as PIMs were proton pump inhibitors (PPIs) and benzodiazepines (BZDs), present in 345 (46.6%) patients. This outcome was found significantly associated with age, polypharmacy and essential tremor in an explanatory model with 71% AUC. Conclusions PIMs at admission are highly prevalent in these patients, especially those involving PPIs or BZDs, which affected almost half of the patients. Therefore, these drugs may be considered as the starting point for medication review and deprescription. Trial registration number NCT02830425

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Ability to detect potentially inappropriate prescribing in older patients: comparative analysis between PIM-Check and STOPP/STARTv2

European Journal of Clinical Pharmacology ◽

10.1007/s00228-021-03171-4 ◽

2021 ◽

Author(s):

Akram Farhat ◽

Alice Panchaud ◽

Amal Al-Hajje ◽

Pierre-Olivier Lang ◽

Chantal Csajka

Keyword(s):

Comparative Analysis ◽

Older Patients ◽

Adverse Drug Events ◽

Inappropriate Prescribing ◽

University Hospital ◽

Potentially Inappropriate Prescribing ◽

Geriatric Ward ◽

Start Criteria ◽

Acute Geriatric Ward ◽

Geriatric Settings

Abstract Purpose Potentially inappropriate prescribing (PIP) is a source of preventable adverse drug events. The objective of this study was a comparative analysis (quantitative and qualitative) between two tools used to detect PIP, PIM-Check and STOPP/START. Methods First, a qualitative analysis (QAC) was conducted to evaluate the concordance between the criteria, which constitute PIM-Check and the gold standard STOPP/START. Second, a retrospective comparative and observational study was performed on the list of treatment at the admission of 50 older patients hospitalized in an acute geriatric ward of a university hospital in Switzerland in 2016 using both tools. Results The QAC has shown that 50% (57 criteria) of STOPP/START criteria are fully or partially concordant with those of PIM-Check. The retrospective study was performed on 50 patients aged 87 years, suffering from 5 co-morbidities (min–max 1–11) and treated by of 8 drugs (min–max 2–16), as medians. The prevalence of the detected PIP was 80% by PIM-Check and 90% by STOPP/START. Medication review shows that 4.2 PIP per patient were detected by PIM-Check and 3.5 PIP by STOPP/START among which 1.9 PIP was commonly detected by both tools, as means. PIM-Check detected more PIP related to cardiology, angiology, nephrology, and endocrinology in older patients but missed the PIP related to geriatric syndromes (e.g., fall, dementia, Alzheimer) detected by STOPP/START. Conclusions By using PIM-Check in geriatric settings, some PIP will not be detected. It is considered as a limitation for this tool in this frail population but brings a certain complementarity in other areas of therapy not covered by STOPP/START.

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Potential inappropriate prescribing among ambulatory elderly patients in a geriatric centre in southwestern Nigeria: Beers criteria versus STOPP/START criteria

Tropical Journal of Pharmaceutical Research ◽

10.4314/tjpr.v19i5.29 ◽

2020 ◽

Vol 19 (5) ◽

pp. 1105-1111

Author(s):

Wuraola Akande-Sholabi ◽

Oluwatobi C. Ajilore ◽

Segun J. Showande ◽

Lawrence A. Adebusoye

Keyword(s):

Elderly Patients ◽

Health Care Professionals ◽

Screening Tool ◽

Data Extraction ◽

Inappropriate Prescribing ◽

Beers Criteria ◽

Potentially Inappropriate Prescribing ◽

Southwestern Nigeria ◽

Start Criteria ◽

Prescribing Omissions

Purpose: To identify potentially inappropriate prescribing in ambulatory elderly patients and compare the appropriateness of guidelines; Beers' and Screening Tool of Older Person’s Prescription (STOPP)/Screening Tool to Alert Right Treatment (START) criteria to detect potentially inappropriate prescribing among the elderly.Methods: A retrospective study was conducted using case files of 335 elderly patients aged ≥ 60 years between 1st January and 31st December 2016, using a data extraction sheet. The 2015 American Geriatrics Society (AGS)-Beers Criteria, and version 2 of the STOPP and START were subsequently used to identify the Potentially Inappropriate Prescribing (PIP) and Potential Prescribing Omissions (PPOs).Results: Mean age of patients was 69 ± 0.4 years (range 60 - 85 years) and 219 (65.4 %) were females. An average of 4.2 medications per patient prescription was found. The Beers criteria identified 26.5 % PIP, while STOPP criteria identified 57.1 % PIP. START detected 29 PPOs in 15 (4.4 %) of the patient’s prescription. The most prevalent disease conditions were hypertension 235 (70.1 %) and osteoarthritis 64 (19.3 %). Polypharmacy was significantly associated with PIP in both Beers (p = 0.002) and STOPP (p = 0.001) criteria.Conclusion: The prevalence of PIP is high among elderly patients. The STOPP/START criteria identified a higher proportion of PIP among elderly patients compared with Beers criteria. The frequency of PIP should stimulate efforts to curtail potentially inappropriate prescribing and may require the need for advocating for a national criterion to be adopted by health care professionals in Nigeria. Keywords: Potential inappropriate prescribing, Beers’ criteria, STOPP/START criteria, Elderly

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Inappropriate prescribing among ambulatory elderly patients in a geriatric centre in Southwestern Nigeria

10.21203/rs.2.11071/v1 ◽

2019 ◽

Author(s):

Wuraola Akande-Sholabi ◽

Oluwatobi Ajilore ◽

Segun J Showande ◽

Lawrence A Adebusoye

Keyword(s):

Health Care Professionals ◽

Screening Tool ◽

Inappropriate Medication ◽

Inappropriate Prescribing ◽

Health Concern ◽

Beers Criteria ◽

Potentially Inappropriate Prescribing ◽

Southwestern Nigeria ◽

Start Criteria ◽

Case Files

Abstract Background: Inappropriate medication prescribing is a common, major global health concern among the elderly. There are no guidelines to detect potentially inappropriate prescribing in Nigeria among the elderly. Therefore, this study compared the appropriateness of Beers' and Screening Tool of Older Person’s Prescription (STOPP)/ Screening Tool to Alert Right Treatment (START) criteria to identify potentially inappropriate prescribing in ambulatory elderly patients in Nigeria. Methods: A retrospective study at the geriatric centre, University College Hospital, Ibadan was conducted using systematically selected case files of 335 elderly patients aged ≥ 60 years between 1st January and 31st December 2016. With the aid of a data extraction sheet, information on the socio-demographic characteristics, drug utilisation pattern and morbidities were obtained from the most recent prescription in the case files. The 2015 American Geriatrics Society (AGS)-Beers Criteria, and version 2 of the STOPP and START were subsequently used to identify the Potentially Inappropriate Prescribing (PIP) and Potential Prescribing Omissions (PPOs). Associations between polypharmacy (≥ 5 medications) and multimorbidity (presence of 2 or more diseases), and AGS Beers and STOPP/START criteria were determined with Chi-square test at p <0.05. Results: Mean age of patients was 69 ± 0.4 years (range 60-85 years) and 219 (65.4%) were females. An average of 4.2 medications per patient prescription was found. The Beers criteria identified 26.5% PIMs, while STOPP criteria identified 57.1% PIMs. START detected 29 PPOs in 15 (4.4%) of the patient’s prescription. The most prevalent disease conditions were hypertension 235 (70.1%) and osteoarthritis 64 (19.3%). Polypharmacy was significantly associated with PIMs use in both Beers (p=0.002) and STOPP (p=0.001) criteria. Conclusions: The prevalence of PIP is high among the elderly patients. The STOPP/START criteria identified a higher proportion of PIMs among elderly patients compared with Beers criteria. The frequency of PIP should stimulate efforts to curtail potentially inappropriate prescribing and may require the need for advocating for a national criteria to be adopted by health care professionals in Nigeria. Keywords: Inappropriate prescribing, Beers’ criteria, STOPP/START criteria, Elderly, Nigeria

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