RESUMEN
PURPOSE: To comparatively assess the prevalence rates of potentially inappropriate medications (PIMs) obtained by the former and latest versions of American Geriatrics Society Beers Criteria (AGS BC) and screening tool of older person's potentially inappropriate prescriptions (STOPP), and analyze the factors of influence on PIM. METHODS: Cross-sectional study including 582 community-dwelling older adults over the age of 65. Sociodemographic, clinical, functional, and comprehensive drug therapy data were collected. The primary endpoint was the percentage of patients receiving at least one PIM. RESULTS: A total of 3626 prescriptions were analyzed. PIMs were detected in 35.4% and 47.9% of patients according to the STOPP v1 and the 2012 AGS BC, respectively. This percentage rose to 54% when 2015 AGS BC were used and reached 66.8% with STOPP v2. The kappa coefficient between STOPP v2 and its former version was lower than the one between the updated Beers Criteria and their former version (0.41 vs 0.85). The agreement was good (0.65) between both latest criteria. The number of medications, psychological disorders, and insomnia were predictors of PIM. A novel finding was that bone and joint disorders increased the odds for PIM by 78%. CONCLUSIONS: The 2015 AGS BC showed high sensitivity and good applicability to the European older patients. Both updated tools identified some pharmacological groups (benzodiazepines, PPIs, and opioids, among others) and certain health problems (insomnia, psychological disorders, and osteoarticular diseases) as factors of influence on PIM. Based on these findings, interventions aimed at promoting appropriate use of medications should be developed.
Asunto(s)
Vida Independiente , Lista de Medicamentos Potencialmente Inapropiados/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Factores de Riesgo , EspañaRESUMEN
PURPOSE: The aim of this study was to measure the prevalence of potentially inappropriate medications (PIMs) by using the EU(7)-PIM list, STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) version 2 criteria and the new comprehensive protocol. METHODS: This prospective study involved a sample of 276 consecutive elderly patients discharged from the university teaching hospital. Age, gender, diagnoses, medication history and medicines at discharge were recorded. The main outcome measure was the prevalence of PIMs according to each set of criteria: EU(7)-PIM list, STOPP version 2 criteria and comprehensive protocol. RESULTS: The median patient age (range) was 74 (65-92) years. The median number of prescribed medications was 7 (1-17). STOPP identified 393 PIMs affecting 190 patients (69%), EU(7)-PIM list identified 330 PIMs in 184 patients (66.7%) whilst the comprehensive protocol identified 134 PIMs in 102 patients (37%). STOPP version 2 criteria identified significantly more PIMs per patient than the other two protocols (p < 0.001). Gender (p = 0.002), glomerular filtration rate (p = 0.039) and number of comorbidities (p = 0.001) were associated with the proportion of PIMs for the STOPP version 2 criteria only. CONCLUSION: A very high PIM prevalence at discharge was reported suggesting the urgent need for actions to reduce them. STOPP version 2 criteria identified significantly more PIMs than the EU(7)-PIM list and the comprehensive protocol and was found as a more sensitive tool for PIM detection.
Asunto(s)
Hospitales Universitarios/estadística & datos numéricos , Prescripción Inadecuada/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Croacia , Femenino , Hospitalización , Humanos , Masculino , Lista de Medicamentos Potencialmente InapropiadosRESUMEN
RATIONALE, AIMS AND OBJECTIVES: Explicit criteria have been used worldwide to identify suboptimal prescribing such as potentially inappropriate prescriptions (PIPs). The objective of our study was to determine prevalence, types and factors associated with PIPs in older people discharged from an Albanian hospital. METHOD: Retrospective, cross-sectional study conducted among patients aged 60 years and more discharged from the Cardiology and Internal Medicine departments of the University Hospital Center 'Mother Theresa' Tirana during 2013. PIPs were identified by using Beers (2012 update) and STOPP criteria (2008 and 2014 versions). Chi-square analysis and Student Test were performed. Crude and adjusted odds ratios with their 95% confidence intervals were estimated by logistic regression analysis. RESULTS: Medical files for 319 patients were assessed. The median number of drugs prescribed was 7.8 (SD 2.2). PIPs prevalence at hospital discharge was 34.5% (95% CI 27.5-42.2%; 110 patients) according to both Beers and STOPP version 1 criteria. STOPP version 2 identified 201 (63.0%) patients with at least one PIP (95% CI 55.2-70.2%; 312 PIPs). The drugs more frequently involved in PIPs were aspirin, spironolactone, benzodiazepines, digoxin and methyldopa. The odds of having a PIP were higher in patients discharged from Internal Medicine (P < 0.005). The PIP index was 0.056%, 0.054% and 0.125% respectively for Beers, STOPP 2008 and STOPP 2014 criteria. A significant positive correlation was found between the number of prescribed drugs and PIP occurrence. CONCLUSIONS: Our study found that between one and two out of three older patients has at least one PIP among the treatment prescribed at hospital discharge, depending on the tool used for detection. The high frequency of PIPs suggests the urgent need for interventions to reduce them.