Assessment of Potentially Inappropriate Prescribed Medications in Older Patients Using STOPP/START Criteria at Soba University Hospital: A Descriptive Retrospective Study
Abstract
Background: Potentially inappropriate prescriptions (PIPs) have significant clinical, humanistic, and economic impacts. Identifying PIPs may reduce their burden of adverse drug events. “Screening Tool of Older Person's potentially inappropriate Prescriptions (STOPP) and Screening Tool of Alert doctors to the Right Treatment (START) criteria” are promising tools that formulated to identify potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) in geriatrics. To determine the PIMs and PPOs using STOPP/START criteria and to determine the most frequent PIPs. Methods: The study was a descriptive cross-sectional hospital-based retrospective study. Medical files of elderly (≥65 years) patients admitted to the internal medicine unit at Soba university hospital from January to July 2020 were used. Data were collected using a checklist of STOPP/START criteria (version 2) to determine PIPs. Statistical package for social sciences was used for data analysis. Results: A total of 100 patients were included, around 59% were aged between 65-70 years, and 58% were males. The mean number of medications was 5.3 ± 1.9 drugs/patient. The results showed that the prevalence of PIPs was 68%. The STOPP criteria detected 209 PIMs in 42 patients, whereas the START criteria detected 155 PPOs in 45 patients. Furthermore, the drugs that used beyond the indication period was the most common PIMs, whereas the most detected PPOs were observed in the cardiovascular system medications. Conclusion: The study revealed a high prevalence of PIPs among elderly patients. This necessitates a further evaluation of its impact on clinical outcomes and implements interventions to improve prescribing practice.
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2. Hedna K, Hakkarainen KM, Gyllensten H, Jönsson AK, Petzold M, Hägg S. Potentially inappropriate prescribing and adverse drug reactions in the elderly: a population-based study. Eur J Clin Pharmacol 2015;71(12):1525-33.
3. Wallace E, McDowell R, Bennett K, Fahey T, Smith SM. Impact of Potentially Inappropriate Prescribing on Adverse Drug Events, Health Related Quality of Life and Emergency Hospital Attendance in Older People Attending General Practice: A Prospective Cohort Study. J Gerontol A Biol Sci Med Sci 2017;72(2):271-7.
4. O'Connor MN, Gallagher P, O'Mahony D. Inappropriate prescribing: criteria, detection and prevention. Drugs Aging 2012;29(6):437-52.
5. Curtin D, Gallagher PF, O'Mahony D. Explicit criteria as clinical tools to minimize inappropriate medication use and its consequences. Ther Adv Drug Saf 2019;10:2042098619829431-.
6. Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol 2004;57(1):6-14.
7. Hill-Taylor B, Sketris I, Hayden J, Byrne S, O'Sullivan D, Christie R. Application of the STOPP/START criteria: a systematic review of the prevalence of potentially inappropriate prescribing in older adults, and evidence of clinical, humanistic and economic impact. J Clin Pharm Ther 2013;38(5):360-72.
8. Hartholt KA, van Beeck EF, Polinder S, et al. Societal consequences of falls in the older population: injuries, healthcare costs, and long-term reduced quality of life. J Trauma 2011;71(3):748-53.
9. 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.
10. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. Tools for Assessment of the Appropriateness of Prescribing and Association with Patient-Related Outcomes: A Systematic Review. Drugs Aging 2018;35(1):43-60.
11. Pazan F, Weiss C, Wehling M. The EURO-FORTA (Fit fOR The Aged) List: International Consensus Validation of a Clinical Tool for Improved Drug Treatment in Older People. Drugs Aging 2018;35(1):61-71.
12. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc 2019;67(4):674-94.
13. Sallevelt BTGM, Huibers CJA, Knol W, Puijenbroek Ev, Egberts T, Wilting I. Evaluation of clarity of the STOPP/START criteria for clinical applicability in prescribing for older people: a quality appraisal study. BMJ Open 2020;10(2):e033721-e.
14. Curtin D, Gallagher PF, O'Mahony D. Explicit criteria as clinical tools to minimize inappropriate medication use and its consequences. Ther Adv Drug Saf 2019;10(2042098619829431).
15. Fahrni ML, Azmy MT, Usir E, Aziz NA, Hassan Y. Inappropriate prescribing defined by STOPP and START criteria and its association with adverse drug events among hospitalized older patients: A multicentre, prospective study. PLoS One 2019;14(7).
16. Cho H, Choi J, Kim YS, et al. prevalence and predictors of potentially inappropriate prescribing of central nervous system and psychotropic drugs among elderly patients: A national population study in Korea. Arch Gerontol Geriatr 2018;74:1-8.
17. Kimura T, Ogura F, Yamamoto K, et al. Potentially inappropriate medications in elderly Japanese patients: effects of pharmacists' assessment and intervention based on Screening Tool of Older Persons' Potentially Inappropriate Prescriptions criteria ver.2. J Clin Pharm Ther 2017;42(2):209-14.
18. Brown JD, Hutchison LC, Li C, Painter JT, Martin BC. Predictive Validity of the Beers and Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) Criteria to Detect Adverse Drug Events, Hospitalizations, and Emergency Department Visits in the United States. J Am Geriatr Soc 2016;64(1):22-30.
19. Parker K, Bull-Engelstad I, Benth J, et al. Effectiveness of using STOPP/START criteria to identify potentially inappropriate medication in people aged ≥ 65 years with chronic kidney disease: a randomized clinical trial. Eur J Clin Pharmacol 2019;75(11):1503-11.
20. Fadare JO, Desalu OO, Obimakinde AM, Adeoti AO, Agboola SM, Aina FO. Prevalence of inappropriate medication prescription in the elderly in Nigeria: A comparison of Beers and STOPP criteria. Int J Risk Saf Med 2015;27(4):177-89.
21. Cahir C, Bennett K, Teljeur C, Fahey T. Potentially inappropriate prescribing and adverse health outcomes in community dwelling older patients. Brit J Clin Pharmacol 2014;77(1):201-10.
22. 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.
23. García-Gollarte F, Baleriola-Júlvez J, Ferrero-López I, Cruz-Jentoft AJ. Inappropriate drug prescription at nursing home admission. J Am Med Dir Assoc 2012;13(1):30.
24. 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.
25. Parsons C, Johnston S, Mathie E, et al. Potentially inappropriate prescribing in older people with dementia in care homes: a retrospective analysis. Drugs Aging 2012;29(2):143-55.
26. Hughes CM, Cadogan CA, Patton D, Ryan CA. Pharmaceutical strategies towards optimising poly-pharmacy in older people. Int J Pharm. 2016;512(2):360-5.
27. Gallagher P, Lang PO, Cherubini A, et al. prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals. Eur J Clin Pharmacol 2011;67(11):1175-88.
28. Cheung K-S, Leung WK. Gastrointestinal bleeding in patients on novel oral anticoagulants: Risk, prevention and management. World J Gastroenterol 2017;23(11):1954-63.
29. Drini M. Peptic ulcer disease and non-steroidal anti-inflammatory drugs. Aust Prescr 2017;40(3):91-3.
30. Doomra R, Goyal A. NSAIDs and self-medication: A serious concern. J Family Med Prim Care 2020;9(5):2183-5.
31. Barry PJ, Gallagher P, Ryan C, O'Mahony D. START (screening tool to alert doctors to the right treatment)--an evidence-based screening tool to detect prescribing omissions in elderly patients. Age Ageing 2007;36(6):632-8.
32. Liu CL, Peng LN, Chen YT, Lin MH, Liu LK, Chen LK. Potentially inappropriate prescribing (IP) for elderly medical inpatients in Taiwan: a hospital-based study. Arch Gerontol Geriatr 2012;55(1):148-51.
2. Hedna K, Hakkarainen KM, Gyllensten H, Jönsson AK, Petzold M, Hägg S. Potentially inappropriate prescribing and adverse drug reactions in the elderly: a population-based study. Eur J Clin Pharmacol 2015;71(12):1525-33.
3. Wallace E, McDowell R, Bennett K, Fahey T, Smith SM. Impact of Potentially Inappropriate Prescribing on Adverse Drug Events, Health Related Quality of Life and Emergency Hospital Attendance in Older People Attending General Practice: A Prospective Cohort Study. J Gerontol A Biol Sci Med Sci 2017;72(2):271-7.
4. O'Connor MN, Gallagher P, O'Mahony D. Inappropriate prescribing: criteria, detection and prevention. Drugs Aging 2012;29(6):437-52.
5. Curtin D, Gallagher PF, O'Mahony D. Explicit criteria as clinical tools to minimize inappropriate medication use and its consequences. Ther Adv Drug Saf 2019;10:2042098619829431-.
6. Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol 2004;57(1):6-14.
7. Hill-Taylor B, Sketris I, Hayden J, Byrne S, O'Sullivan D, Christie R. Application of the STOPP/START criteria: a systematic review of the prevalence of potentially inappropriate prescribing in older adults, and evidence of clinical, humanistic and economic impact. J Clin Pharm Ther 2013;38(5):360-72.
8. Hartholt KA, van Beeck EF, Polinder S, et al. Societal consequences of falls in the older population: injuries, healthcare costs, and long-term reduced quality of life. J Trauma 2011;71(3):748-53.
9. 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.
10. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. Tools for Assessment of the Appropriateness of Prescribing and Association with Patient-Related Outcomes: A Systematic Review. Drugs Aging 2018;35(1):43-60.
11. Pazan F, Weiss C, Wehling M. The EURO-FORTA (Fit fOR The Aged) List: International Consensus Validation of a Clinical Tool for Improved Drug Treatment in Older People. Drugs Aging 2018;35(1):61-71.
12. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc 2019;67(4):674-94.
13. Sallevelt BTGM, Huibers CJA, Knol W, Puijenbroek Ev, Egberts T, Wilting I. Evaluation of clarity of the STOPP/START criteria for clinical applicability in prescribing for older people: a quality appraisal study. BMJ Open 2020;10(2):e033721-e.
14. Curtin D, Gallagher PF, O'Mahony D. Explicit criteria as clinical tools to minimize inappropriate medication use and its consequences. Ther Adv Drug Saf 2019;10(2042098619829431).
15. Fahrni ML, Azmy MT, Usir E, Aziz NA, Hassan Y. Inappropriate prescribing defined by STOPP and START criteria and its association with adverse drug events among hospitalized older patients: A multicentre, prospective study. PLoS One 2019;14(7).
16. Cho H, Choi J, Kim YS, et al. prevalence and predictors of potentially inappropriate prescribing of central nervous system and psychotropic drugs among elderly patients: A national population study in Korea. Arch Gerontol Geriatr 2018;74:1-8.
17. Kimura T, Ogura F, Yamamoto K, et al. Potentially inappropriate medications in elderly Japanese patients: effects of pharmacists' assessment and intervention based on Screening Tool of Older Persons' Potentially Inappropriate Prescriptions criteria ver.2. J Clin Pharm Ther 2017;42(2):209-14.
18. Brown JD, Hutchison LC, Li C, Painter JT, Martin BC. Predictive Validity of the Beers and Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) Criteria to Detect Adverse Drug Events, Hospitalizations, and Emergency Department Visits in the United States. J Am Geriatr Soc 2016;64(1):22-30.
19. Parker K, Bull-Engelstad I, Benth J, et al. Effectiveness of using STOPP/START criteria to identify potentially inappropriate medication in people aged ≥ 65 years with chronic kidney disease: a randomized clinical trial. Eur J Clin Pharmacol 2019;75(11):1503-11.
20. Fadare JO, Desalu OO, Obimakinde AM, Adeoti AO, Agboola SM, Aina FO. Prevalence of inappropriate medication prescription in the elderly in Nigeria: A comparison of Beers and STOPP criteria. Int J Risk Saf Med 2015;27(4):177-89.
21. Cahir C, Bennett K, Teljeur C, Fahey T. Potentially inappropriate prescribing and adverse health outcomes in community dwelling older patients. Brit J Clin Pharmacol 2014;77(1):201-10.
22. 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.
23. García-Gollarte F, Baleriola-Júlvez J, Ferrero-López I, Cruz-Jentoft AJ. Inappropriate drug prescription at nursing home admission. J Am Med Dir Assoc 2012;13(1):30.
24. 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.
25. Parsons C, Johnston S, Mathie E, et al. Potentially inappropriate prescribing in older people with dementia in care homes: a retrospective analysis. Drugs Aging 2012;29(2):143-55.
26. Hughes CM, Cadogan CA, Patton D, Ryan CA. Pharmaceutical strategies towards optimising poly-pharmacy in older people. Int J Pharm. 2016;512(2):360-5.
27. Gallagher P, Lang PO, Cherubini A, et al. prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals. Eur J Clin Pharmacol 2011;67(11):1175-88.
28. Cheung K-S, Leung WK. Gastrointestinal bleeding in patients on novel oral anticoagulants: Risk, prevention and management. World J Gastroenterol 2017;23(11):1954-63.
29. Drini M. Peptic ulcer disease and non-steroidal anti-inflammatory drugs. Aust Prescr 2017;40(3):91-3.
30. Doomra R, Goyal A. NSAIDs and self-medication: A serious concern. J Family Med Prim Care 2020;9(5):2183-5.
31. Barry PJ, Gallagher P, Ryan C, O'Mahony D. START (screening tool to alert doctors to the right treatment)--an evidence-based screening tool to detect prescribing omissions in elderly patients. Age Ageing 2007;36(6):632-8.
32. Liu CL, Peng LN, Chen YT, Lin MH, Liu LK, Chen LK. Potentially inappropriate prescribing (IP) for elderly medical inpatients in Taiwan: a hospital-based study. Arch Gerontol Geriatr 2012;55(1):148-51.
| Files | ||
| Issue | Vol 10, No 1 (Winter 2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jpc.v10i1.9122 | |
| Keywords | ||
| Potentially Inappropriate Medications Polypharmacy STOPP/START Geriatric Assessment | ||
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How to Cite
1.
Mohammed A, Ahmed K, Yousef B. Assessment of Potentially Inappropriate Prescribed Medications in Older Patients Using STOPP/START Criteria at Soba University Hospital: A Descriptive Retrospective Study. J Pharm Care. 2022;10(1):3-10.
