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Drugs & Aging
Published in: Drugs & Aging 5/2019

01-05-2019 | Original Research Article

Potentially Inappropriate Prescribing and Related Hospital Admissions in Geriatric Patients: A Comparative Analysis between the STOPP and START Criteria Versions 1 and 2

Authors: Stefanie Thevelin, Leïla El Mounaouar, Sophie Marien, Benoit Boland, Séverine Henrard, Olivia Dalleur

Published in: Drugs & Aging | Issue 5/2019

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Abstract

Background

Older persons are at significant risk of drug-related admissions (DRAs). We previously demonstrated that 27% of hospitalizations in geriatric patients were associated with potentially inappropriate medicines (PIMs) and/or potential prescribing omissions (PPOs) identified by the Screening Tool of Older People’s Prescriptions/Screening Tool to Alert to Right Treatment (STOPP/START) criteria version 1 (v1). The updated STOPP/START criteria version 2 (v2) comprised a 31% increase in prescribing criteria.

Objective

As a secondary analysis of our study conducted in 2008, we aimed to compare the prevalence and types of DRAs identified by STOPP/START.v1 and STOPP/START.v2.

Methods

We applied the STOPP/START.v2 criteria to a subset of 100 consecutively admitted geriatric patients selected from our original cross-sectional study of 302 patients. A geriatrician and a pharmacist adjudicated whether the identified PIMs and PPOs were related to acute hospitalization. Admissions were defined as DRAs if the identified PIM(s) and/or PPO(s) were related to the main cause of admission or played a significant contributory role in the admission.

Results

The median patient age was 83 years and the median number of medications at home was 8. Compared with STOPP/START.v1, STOPP/START.v2 not only yielded more instances of inappropriate prescribing but also targeted significantly more PIMs and PPOs associated with preventable DRAs (23% vs. 40% of all admissions, p < 0.001). PIMs of fall-risk-increasing drugs, and PPOs of musculoskeletal and cardiovascular system drugs, were most frequently associated with DRAs.

Conclusion

The latter instances of inappropriate prescribing with major clinical relevance warrant particular attention during medication review in older persons.
Appendix
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Literature
1.
Parameswaran Nair N, Chalmers L, Peterson GM, Bereznicki BJ, Castelino RL, Bereznicki LR. Hospitalization in older patients due to adverse drug reactions: the need for a prediction tool. Clin Interv Aging. 2016;11:497–505.CrossRefPubMedPubMedCentral
2.
El Morabet N, Uitvlugt EB, van den Bemt BJF, van den Bemt P, Janssen MJA, Karapinar-Carkit F. Prevalence and preventability of drug-related hospital readmissions: a systematic review. J Am Geriatr Soc. 2018;66(3):602–8.CrossRefPubMed
3.
Ernst FR, Grizzle AJ. Drug-related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc (Wash). 2001;41(2):192–9.CrossRef
4.
Leendertse AJ, Van Den Bemt PM, Poolman JB, Stoker LJ, Egberts AC, Postma MJ. Preventable hospital admissions related to medication (HARM): cost analysis of the HARM study. Value Health. 2011;14(1):34–40.CrossRefPubMed
5.
Leendertse AJ, Egberts AC, Stoker LJ, van den Bemt PM. Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch Intern Med. 2008;168(17):1890–6.PubMed
6.
Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011;365(21):2002–12.CrossRefPubMed
7.
Runciman WB, Roughead EE, Semple SJ, Adams RJ. Adverse drug events and medication errors in Australia. Int J Qual Health Care. 2003;15(Suppl 1):i49–59.CrossRefPubMed
8.
Franceschi M, Scarcelli C, Niro V, Seripa D, Pazienza AM, Pepe G, et al. Prevalence, clinical features and avoidability of adverse drug reactions as cause of admission to a geriatric unit: a prospective study of 1756 patients. Drug Saf. 2008;31(6):545–56.CrossRefPubMed
9.
Dalleur O, Spinewine A, Henrard S, Losseau C, Speybroeck N, Boland B. Inappropriate prescribing and related hospital admissions in frail older persons according to the STOPP and START criteria. Drugs Aging. 2012;29(10):829–37.CrossRefPubMed
10.
Hamilton H, Gallagher P, Ryan C, Byrne S, O’Mahony D. Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients. Arch Intern Med. 2011;171(11):1013–9.CrossRefPubMed
11.
van der Stelt CA, Vermeulen Windsant-van den Tweel AM, Egberts AC, van den Bemt PM, Leendertse AJ, Hermens WA, et al. The association between potentially inappropriate prescribing and medication-related hospital admissions in older patients: a nested case control study. Drug Saf. 2016;39(1):79–87.
12.
Gallagher P, O’Mahony D. STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers’ criteria. Age Ageing. 2008;37(6):673–9.CrossRefPubMed
13.
Spinewine A, Schmader KE, Barber N, Hughes C, Lapane KL, Swine C, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet. 2007;370(9582):173–84.CrossRefPubMed
14.
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.
15.
O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44(2):213–8.CrossRefPubMed
16.
Boland B, Guignard B, Dalleur O, Lang P-O. Application of STOPP/START and Beers criteria: compared analysis on identification and relevance of potentially inappropriate prescriptions. Eur Geriatr Med. 2016;7(5):416–23.CrossRef
17.
Blanco-Reina E, Garcia-Merino MR, Ocana-Riola R, Aguilar-Cano L, Valdellos J, Bellido-Estevez I, et al. Assessing potentially inappropriate prescribing in community-dwelling older patients using the updated version of STOPP-START criteria: a comparison of profiles and prevalences with respect to the original version. PLoS One. 2016;11(12):e0167586.CrossRefPubMedPubMedCentral
18.
McCusker J, Bellavance F, Cardin S, Belzile E, Verdon J. Prediction of hospital utilization among elderly patients during the 6 months after an emergency department visit. Ann Emerg Med. 2000;36(5):438–45.PubMed
19.
Deschodt M, Braes T, Broos P, Sermon A, Boonen S, Flamaing J, et al. Effect of an inpatient geriatric consultation team on functional outcome, mortality, institutionalization, and readmission rate in older adults with hip fracture: a controlled trial. J Am Geriatr Soc. 2011;59(7):1299–308.CrossRefPubMed
20.
Hallas J, Harvald B, Gram LF, Grodum E, Brosen K, Haghfelt T, et al. Drug related hospital admissions: the role of definitions and intensity of data collection, and the possibility of prevention. J Intern Med. 1990;228(2):83–90.CrossRefPubMed
21.
Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam Med. 2005;37(5):360–3.PubMed
22.
Counter D, Millar JWT, McLay JS. Hospital readmissions, mortality and potentially inappropriate prescribing: a retrospective study of older adults discharged from hospital. Br J Clin Pharmacol. 2018;84(8):1757–63.CrossRefPubMedPubMedCentral
23.
Wauters M, Elseviers M, Vaes B, Degryse J, Dalleur O, Vander Stichele R, et al. Too many, too few, or too unsafe? Impact of inappropriate prescribing on mortality, and hospitalization in a cohort of community-dwelling oldest old. Br J Clin Pharmacol. 2016;82(5):1382–92.CrossRefPubMedPubMedCentral
24.
Lang PO, Petrovic M, Dalleur O, Ferahta M, Benetos A, Boland B. The exercise in applying STOPP/START.v2 in vulnerable very old patients: Towards patient tailored prescribing. Eur Geriatr Med. 2016;7(2):176–9.
25.
Holmes HM, Hayley DC, Alexander GC, Sachs GA. Reconsidering medication appropriateness for patients late in life. Arch Intern Med. 2006;166(6):605–9.CrossRefPubMed
26.
Fischhoff B. Hindsight not equal to foresight: the effect of outcome knowledge on judgment under uncertainty. 1975. Qual Saf Health Care. 2003;12(4):304–11 (discussion 11–2).
27.
Thevelin S, Spinewine A, Beuscart JB, Boland B, Marien S, Vaillant F, et al. Development of a standardized chart review method to identify drug-related hospital admissions in older people. Br J Clin Pharmacol. 2018;84(11):2600–14.CrossRefPubMed
28.
Phansalkar S, Hoffman JM, Nebeker JR, Hurdle JF. Pharmacists versus nonpharmacists in adverse drug event detection: a meta-analysis and systematic review. Am J Health Syst Pharm. 2007;64(8):842–9.CrossRefPubMed
29.
van Doormaal JE, Mol PG, van den Bemt PM, Zaal RJ, Egberts AC, Kosterink JG, et al. Reliability of the assessment of preventable adverse drug events in daily clinical practice. Pharmacoepidemiol Drug Saf. 2008;17(7):645–54.CrossRefPubMed
Metadata
Title
Potentially Inappropriate Prescribing and Related Hospital Admissions in Geriatric Patients: A Comparative Analysis between the STOPP and START Criteria Versions 1 and 2
Authors
Stefanie Thevelin
Leïla El Mounaouar
Sophie Marien
Benoit Boland
Séverine Henrard
Olivia Dalleur
Publication date
01-05-2019
Publisher
Springer International Publishing
Published in
Drugs & Aging / Issue 5/2019
Print ISSN: 1170-229X
Electronic ISSN: 1179-1969
DOI
https://doi.org/10.1007/s40266-018-00635-8

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