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Drugs & Aging
Published in: Drugs & Aging 2/2017

01-02-2017 | Original Research Article

Combined Use of the Rationalization of Home Medication by an Adjusted STOPP in Older Patients (RASP) List and a Pharmacist-Led Medication Review in Very Old Inpatients: Impact on Quality of Prescribing and Clinical Outcome

Authors: Lorenz Van der Linden, Liesbeth Decoutere, Karolien Walgraeve, Koen Milisen, Johan Flamaing, Isabel Spriet, Jos Tournoy

Published in: Drugs & Aging | Issue 2/2017

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Abstract

Background

Polypharmacy and potentially inappropriate drugs have been associated with negative outcomes in older adults which might be reduced by pharmacist interventions.

Objectives

Our objective was to evaluate the effect of a pharmacist intervention, consisting of the application of the Rationalization of home medication by an Adjusted STOPP in older Patients (RASP) list and a pharmacist-led medication review on polypharmacy, the quality of prescribing, and clinical outcome in geriatric inpatients.

Methods

A monocentric, prospective controlled trial was undertaken at the geriatric wards of a large university hospital. Pharmacists applied the RASP list to the drugs reconciled on admission and additionally performed an expert-based medication review, upon which recommendations were provided to the treating physicians. The primary outcome was the composite endpoint of drug discontinuation and dose reduction of drugs taken on admission. Secondary outcomes included RASP-identified potentially inappropriate medications (PIMs), the number of Emergency Department (ED) visits and quality of life (QOL) registered up to 3 months after discharge.

Results

On average, patients (n = 172) took 10 drugs on admission and were 84.5 years (standard deviation 4.8) of age. More drugs were discontinued or reduced in dose in the intervention group {control vs. intervention: median (interquartile range [IQR]) 3 (2–5) vs. 5 (3–7); p < 0.001}. More PIMs were discontinued in the intervention group, leading to less PIM at discharge [control vs. intervention: median (IQR) 2 (1–3) vs. 0.5 (0–1); p < 0.001]. No signal of harm was seen, and a significant improvement of QOL and less ED visits without hospitalization were observed.

Conclusions

The combined intervention safely reduced drug use in very old inpatients and outperformed usual geriatric care. An increased QOL was seen, as well as a trend towards less ED visits.
ClinicalTrials.gov Identifier: NCT01513265.
Literature
1.
Hovstadius B, Hovstadius K, Astrand B, Petersson G. Increasing polypharmacy: an individual-based study of the Swedish population 2005–2008. BMC Clin Pharmacol. 2010;10:16.CrossRefPubMedPubMedCentral
2.
3.
4.
Cherubini A, Oristrell J, Pla X, et al. The persistent exclusion of older patients from ongoing clinical trials regarding heart failure. Arch Intern Med. 2011;171(6):550–6.CrossRefPubMed
5.
Wehling M. Guideline-driven polypharmacy in elderly, multimorbid patients is basically flawed: there are almost no guidelines for these patients. J Am Geriatr Soc. 2011;59(2):376–7.CrossRefPubMed
6.
Holmes HM, Min LC, Yee M, et al. Rationalizing prescribing for older patients with multimorbidity: considering time to benefit. Drugs Aging. 2013;30(9):655–66.CrossRefPubMedPubMedCentral
7.
Brunner-La Rocca HP, Rickenbacher P, Muzzarelli S, et al. End-of-life preferences of elderly patients with chronic heart failure. Eur Heart J. 2012;33(6):752–9.CrossRefPubMed
8.
Gheorghe C, Vazquez R, Casanegra AI, et al. Elders’ environs and their end-of-life preferences. J Am Med Dir Assoc. 2011;12(1):22–8.CrossRefPubMed
9.
Gallagher P, Barry P, O’Mahony D. Inappropriate prescribing in the elderly. J Clin Pharm Ther. 2007;32(2):113–21.CrossRefPubMed
10.
Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005;294(6):716–24.
11.
Cahir C, Bennett K, Teljeur C, Fahey T. Potentially inappropriate prescribing and adverse health outcomes in community dwelling older patients. Br J Clin Pharmacol. 2014;77(1):201–10.CrossRefPubMed
12.
Laroche ML, Charmes JP, Nouaille Y, Picard N, Merle L. Is inappropriate medication use a major cause of adverse drug reactions in the elderly? Br J Clin Pharmacol. 2007;63(2):177–86.CrossRefPubMed
13.
Mannesse CK, Derkx FH, de Ridder MA, Man in ‘t Veld AJ, van der Cammen TJ. Contribution of adverse drug reactions to hospital admission of older patients. Age Ageing. 2000;29(1):35–9.CrossRefPubMed
14.
Schoenenberger AW, Stuck AE. Inappropriate drug use among older persons: is it time for action? Age Ageing. 2014;43(6):737–9.CrossRefPubMed
15.
Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57–65.CrossRefPubMed
16.
Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D. STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46(2):72–83.CrossRefPubMed
17.
Samsa GP, Hanlon JT, Schmader KE, et al. A summated score for the medication appropriateness index: development and assessment of clinimetric properties including content validity. J Clin Epidemiol. 1994;47(8):891–6.CrossRefPubMed
18.
Pretorius RW, Gataric G, Swedlund SK, Miller JR. Reducing the risk of adverse drug events in older adults. Am Fam Physician. 2013;87(5):331–6.PubMed
19.
Spinewine A, Schmader KE, Barber N, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet. 2007;370(9582):173–84.CrossRefPubMed
20.
Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163(22):2716–24.CrossRefPubMed
21.
Frankenthal D, Lerman Y, Kalendaryev E. Intervention with the screening tool of older persons potentially inappropriate prescriptions/screening tool to alert doctors to right treatment criteria in elderly residents of a chronic geriatric facility: a randomized clinical trial. J Am Geriatr Soc. 2014;62(9):1658–65.CrossRefPubMed
22.
Nobili A, Licata G, Salerno F, et al. Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wards. The REPOSI study. Eur J Clin Pharmacol. 2011;67(5):507–19.CrossRefPubMed
23.
Christensen M, Lundh A. Medication review in hospitalised patients to reduce morbidity and mortality. Cochrane Database Syst Rev. 2013;(2):CD008986.
24.
Tjia J, Velten SJ, Parsons C, Valluri S, Briesacher BA. Studies to reduce unnecessary medication use in frail older adults: a systematic review. Drugs Aging. 2013;30(5):285–307.CrossRefPubMed
25.
Gillespie U, Alassaad A, Hammarlund-Udenaes M, et al. Effects of pharmacists’ interventions on appropriateness of prescribing and evaluation of the instruments’ (MAI, STOPP and STARTs’) ability to predict hospitalization: analyses from a randomized controlled trial. PLoS One. 2013;8(5):e62401.CrossRefPubMedPubMedCentral
26.
Verdoorn S, Kwint HF, Faber A, Gussekloo J, Bouvy ML. Majority of drug-related problems identified during medication review are not associated with STOPP/START criteria. Eur J Clin Pharmacol. 2015;71(10):1255–62.CrossRefPubMedPubMedCentral
27.
Renaudin P, Boyer L, Esteve MA, Bertault-Peres P, Auquier P, Honore S. Do pharmacist-led medication reviews in hospitals help reduce hospital readmissions? A systematic review and meta-analysis. Br J Clin Pharmacol. 2016;82(6):1660–73.CrossRefPubMed
28.
Petrovic M, Somers A, Onder G. Optimization of geriatric pharmacotherapy: role of multifaceted cooperation in the hospital setting. Drugs Aging. 2016;33(3):179–88.CrossRefPubMed
29.
Van Der Linden L, Decoutere L, Flamaing J, et al. Development and validation of the RASP list (Rationalization of Home Medication by an Adjusted STOPP list in Older Patients): a novel tool in the management of geriatric polypharmacy. Eur Geriatr Med. 2014;5(3):175–80.CrossRef
30.
De Winter S, Vanbrabant P, Spriet I, et al. A simple tool to improve medication reconciliation at the emergency department. Eur J Intern Med. 2011;22(4):382–5.CrossRefPubMed
31.
Katz S, Akpom CA. 12. Index of ADL. Med Care. 1976;14(5 Suppl):116–8.
32.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.CrossRefPubMed
33.
EuroQol Group. EuroQol: a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199–208.CrossRef
34.
Schuurmans MJ, Shortridge-Baggett LM, Duursma SA. The Delirium Observation Screening Scale: a screening instrument for delirium. Res Theory Nurs Pract. 2003;17(1):31–50.CrossRefPubMed
35.
Gillespie U, Alassaad A, Henrohn D, et al. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial. Arch Intern Med. 2009;169(9):894–900.CrossRefPubMed
36.
The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31.CrossRef
37.
Cleemput I. A social preference valuations set for EQ-5D health states in Flanders, Belgium. Eur J Health Econ. 2010;11(2):205–13.CrossRefPubMed
38.
Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175–91.CrossRefPubMed
39.
Altman DG, Schulz KF, Moher D, et al. The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med. 2001;134(8):663–94.CrossRefPubMed
40.
Steinman MA, Rosenthal GE, Landefeld CS, Bertenthal D, Kaboli PJ. Agreement between drugs-to-avoid criteria and expert assessments of problematic prescribing. Arch Intern Med. 2009;169(14):1326–32.CrossRefPubMedPubMedCentral
41.
Meulendijk MC, Spruit MR, Drenth-van Maanen AC, et al. Computerized decision support improves medication review effectiveness: an experiment evaluating the STRIP assistant’s usability. Drugs Aging. 2015;32(6):495–503.CrossRefPubMedPubMedCentral
42.
Marriott J, Stehlik P. A critical analysis of the methods used to develop explicit clinical criteria for use in older people. Age Ageing. 2012;41(4):441–50.CrossRefPubMed
43.
Krska J, Cromarty JA, Arris F, et al. Pharmacist-led medication review in patients over 65: a randomized, controlled trial in primary care. Age Ageing. 2001;30(3):205–11.CrossRefPubMed
44.
Hanlon JT, Weinberger M, Samsa GP, et al. A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy. Am J Med. 1996;100(4):428–37.CrossRefPubMed
45.
Bulamu NB, Kaambwa B, Ratcliffe J. A systematic review of instruments for measuring outcomes in economic evaluation within aged care. Health Qual Life Outcomes. 2015;13:179.CrossRefPubMedPubMedCentral
46.
47.
Walters SJ, Brazier JE. Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Qual Life Res. 2005;14(6):1523–32.CrossRefPubMed
48.
Gallagher PF, O’Connor MN, O’Mahony D. Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria. Clin Pharmacol Ther. 2011;89(6):845–54.CrossRefPubMed
49.
Borne R, Cumbler E, Glasheen JJ. Reducing polypharmacy: is hospitalization the right time? Arch Intern Med. 2011;171(9):869–70.CrossRefPubMed
50.
Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med. 2010;170(18):1648–54.CrossRefPubMed
51.
Scott IA, Anderson K, Freeman CR, Stowasser DA. First do no harm: a real need to deprescribe in older patients. Med J Aust. 2014;201(7):390–2.CrossRefPubMed
Metadata
Title
Combined Use of the Rationalization of Home Medication by an Adjusted STOPP in Older Patients (RASP) List and a Pharmacist-Led Medication Review in Very Old Inpatients: Impact on Quality of Prescribing and Clinical Outcome
Authors
Lorenz Van der Linden
Liesbeth Decoutere
Karolien Walgraeve
Koen Milisen
Johan Flamaing
Isabel Spriet
Jos Tournoy
Publication date
01-02-2017
Publisher
Springer International Publishing
Published in
Drugs & Aging / Issue 2/2017
Print ISSN: 1170-229X
Electronic ISSN: 1179-1969
DOI
https://doi.org/10.1007/s40266-016-0424-8

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