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The purpose of this study is to describe the frequency of potential drug prescribing omissions (PPOs) for elderly patients at the time of hospital discharge and to compare the frequency PPOs among different medical specialities. This cross-sectional study examined data from elderly patients when they were admitted for >24 h to a northeastern Brazil teaching hospital during June-December 2016. Were included in the study 227 patients, of whom 36.9% had at least one PPO. The highest number of PPOs was identified among those with at least 5 prescribed drugs. In total, 153 PPOs were identified at hospital discharge. In most cases (78.4%), patients were not evaluated by the specialist physician.The most commonly identified PPOs on discharge were: the omission of statin therapy in cases of diabetes mellitus plus one or more cardiovascular-associated factor; calcium and vitamin D supplements in patients with known osteoporosis; and angiotensin converting enzyme inhibitors in cases of chronic heart failure. The results of this study suggest that the frequency of prescribing omissions PPOs during patient discharge was high. This can be avoided by the careful evaluation by prescribers with experience in certain specialties where several prescribed omissions would be common.

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Background Potentially inappropriate prescribing for older people has become a global concern, although few researchers have analyzed potential prescribing omissions for this population. Objective This study aimed to compare the frequency of potential prescribing omissions for elderly patients at their admission to and discharge from a university hospital in northeast Brazil, using the validated and adapted Brazilian START criteria. Setting A university hospital in northeast Brazil. Methods This cross-sectional study examined data from patients who were ≥ 60 years old when they were admitted for > 24 h to a northeastern Brazil teaching hospital during June-December 2016. Main outcome measure Frequency of potential prescribing omissions for elderly patients at their admission to and discharge. Results Data from 227 patients were included. The mean patient age was 71 ± 8.23 years. The patients included 131 women (57.7%), and 176 patients (77.5%) presented with a Charlson Comorbidity Index of ≥ 3. Based on the START criteria, the frequency of potential prescribing omissions was 44.1% (100/227) at the admission and decreased to 39.6% (90/227) at the discharge. The most common potential omissions at the admission were beta-blockers in cases of stable chronic angina, and angiotensin converting enzyme inhibitors or angiotensin receptor blockers in cases of diabetic nephropathy or renal dysfunction. Conclusion The prevalence of potential prescribing omissions among elderly patients remained relatively high at their discharge from a northeastern Brazilian university hospital. The START criteria could be a useful tool to optimize the clinical management of the elderly.

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CONTEXT AND OBJECTIVE: Non-treatment of diseases or clinical conditions has been considered to constitute omission of care in several countries. The aim of the present study was to develop a transcultural adaptation of the Screening Tool to Alert Doctors to the Right Treatment (START) to Brazilian Portuguese and to validate the tool's content. DESIGN AND SETTING: Cultural adaptation and validation of the START criteria using the Delphi consensus technique. METHOD: START was translated from its original language into Brazilian Portuguese, followed by back-translation and validation by means of the modified Delphi technique. For this, an electronic form was developed and sent to 20 experts, who were asked to use a Likert scale to assess the statements included in START, in relation to their pertinence to Brazilian realities. All of the statements that exhibited mean scores greater than 4.0 were considered to have attained consensus. The experts' identities were kept confidential throughout the validation process. RESULTS: In the first phase of the validation process, 63.6% (14/22) of the statements in START attained consensus. The remaining statements were returned to the experts so that they could have the opportunity to review their comments and statements and to assess them again, based on the Likert scale used earlier. In this phase, 100% of the START instrument attained consensus. CONCLUSION: The content of START was entirely validated for Brazil, with all of the original criteria maintained.

RESUMO CONTEXTO E OBJETIVO: O não tratamento de doenças ou condições clínicas tem sido apontado como omissão no cuidado em diversos países. O objetivo deste estudo foi realizar a adaptação transcultural para o português brasileiro e sua validação de conteúdo do questionário START (Screening Tool to Alert Doctors to the Right Treatment). TIPO DE ESTUDO E LOCAL: Adaptação cultural e validação dos critérios START através da técnica de consenso Delphi. MÉTODO: O START foi submetido à tradução da língua original para o Português (Brasil), tradução reversa e validação de conteúdo por meio da técnica Delphi modificada. Para isso, um formulário eletrônico foi desenvolvido e enviado a 20 especialistas para o julgamento das proposições presentes na ferramenta START conforme sua pertinência para a realidade brasileira, utilizando uma escala de Likert. Foram consideradas consensuais todas as proposições que apresentaram média superior a 4,0. A identificação de cada especialista foi mantida em confidencialidade durante o todo o processo. RESULTADOS: Na primeira fase da validação, foi obtido consenso em 63,6% (14/22) das proposições contidas na ferramenta START. As proposições não consensuais foram reencaminhadas para os especialistas, que tiveram a oportunidade de rever seus comentários e proposições e julgá-las com base na escala de Likert utilizada previamente. Nessa fase, foi obtido consenso em 100% do instrumento START. CONCLUSÃO: O conteúdo do START foi validado para o Brasil na sua totalidade, com todos os critérios originais mantidos.

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RESUMO

CONTEXT AND OBJECTIVE: Non-treatment of diseases or clinical conditions has been considered to constitute omission of care in several countries. The aim of the present study was to develop a transcultural adaptation of the Screening Tool to Alert Doctors to the Right Treatment (START) to Brazilian Portuguese and to validate the tool's content. DESIGN AND SETTING: Cultural adaptation and validation of the START criteria using the Delphi consensus technique. METHOD: START was translated from its original language into Brazilian Portuguese, followed by back-translation and validation by means of the modified Delphi technique. For this, an electronic form was developed and sent to 20 experts, who were asked to use a Likert scale to assess the statements included in START, in relation to their pertinence to Brazilian realities. All of the statements that exhibited mean scores greater than 4.0 were considered to have attained consensus. The experts' identities were kept confidential throughout the validation process. RESULTS: In the first phase of the validation process, 63.6% (14/22) of the statements in START attained consensus. The remaining statements were returned to the experts so that they could have the opportunity to review their comments and statements and to assess them again, based on the Likert scale used earlier. In this phase, 100% of the START instrument attained consensus. CONCLUSION: The content of START was entirely validated for Brazil, with all of the original criteria maintained.

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