Identification of inappropriate prescribing in a Brazilian nursing home using STOPP/START screening tools and the Beers' Criteria

Abstract

The objective of this study was to determine the prevalence of Potentially Inappropriate Medication (PIM) use and associated factors, as well as the prevalence of Prescribing Omissions (PO). A cross-sectional study was conducted in a philanthropic Brazilian nursing home involving 46 individuals aged 60 years or older. The following information was collected from medical records and drug prescriptions: gender, age, health conditions and drugs used in the past thirty days. PIM and PO were identified according to the Beers' Criteria and the STOPP/START screening tools. Over one third (37%) of the population used at least one PIM according to the Beers' Criteria (n=17) and 60.9% according to the STOPP tool. A significant association was found between polypharmacy (use of five or more drugs) and use of PIM according to the Beers' Criteria, but not according to the STOPP. Eight residents (17.4%) were exposed to eight PO. This study allowed the diagnosis of a concerning drug utilization profile with use of a high number of PIMs. Thus, there is an evident need to implement strategies for improving geriatric prescription. O objetivo deste estudo foi determinar a prevalência de uso de medicamentos potencialmente inadequados (MPI) e fatores associados, bem como a prevalência de omissões farmacoterapêuticas (OF). Trata-se de um estudo transversal realizado em uma instituição filantrópica brasileira de longa permanência com 46 indivíduos com 60 anos ou mais. As seguintes informações foram coletadas a partir de prontuários e prescrições: sexo, idade, condições de saúde e medicamentos utilizados nos últimos trinta dias. MPI e OF foram identificados pelo Critério de Beers e as ferramentas de triagem STOPP/START. Mais de um terço (37%) da população utilizou pelo menos, um MPI de acordo com os critérios de Beers (n=17) e 60.9% de acordo com a ferramenta STOPP. Associação estatisticamente significante foi detectada entre a polifarmácia (consumo de cinco ou mais medicamentos) e uso de MPI de acordo com os critérios de Beers, mas não de acordo com o STOPP. Oito residentes (17,4%) foram expostos a oito OF. Este estudo permitiu o diagnóstico de um perfil de utilização de medicamentos preocupante com número elevado de utilização de MPI. Isso indica a necessidade de implementar estratégias para melhorar a qualidade da prescrição geriátrica. UnitermsUnitermos: Farmacoepidemiologia. Atenção farmacêutica. Idoso/uso inapropriado de medicamentos. Medicamentos/prescrição inadequada. Medicamentos/uso inapropriado. Critério de Beers.

Assessing the overall medication use by elderly people in a Brazilian hospital using the start/stopp criteria version 2

“…Strict compliance with clinical protocols should be the standard, otherwise the prescription of numerous medications may occur (Filkelstein et al, 2016b). In this context, it is worth mentioning that some studies have demonstrated that polypharmacy may increase the risk of PIM use (Sánchez-Fidalgo et al, 2017;Filkelstein et al, 2016a;Nascimento et al, 2014). A study conducted by Melo and colleagues (Melo, Storpirtis, Ribeiro, 2016) found that a medication therapy review by a clinical pharmacist resulted in a reduction in polypharmacy and PIMs after the hospitalization period.…”

Uso de medicamentos potencialmente inapropriados em idosos institucionalizados: prevalência e fatores associados

“…These studies collected data in different contexts, such as domiciles 20,22,23,38 , basic care services 21,24 , and they vary in sample size, which justifies this wide prevalence variation. Similarly, Brazilian studies conducted specifically in LTCIEs also show a wide discrepancy among prevalence levels (29.2 to 82.6%) [25][26][27]39 . In these cases, the reduced sample size 26,27,39 and the implementation of the study in only one institution 26,39 decreased the generalization potential.…”

“…The therapeutic classes that determined the high prevalence of PIMs were antipsychotics, benzodiazepines and sulfonylureas, in agreement with previous studies. Brazilian studies have a wide variety of PIM-related prevalence levels, ranging from 24.6% to 82.6% [19][20][21][22][23][24][25][26][27] . These studies collected data in different contexts, such as domiciles 20,22,23,38 , basic care services 21,24 , and they vary in sample size, which justifies this wide prevalence variation.…”

“…However, most of them included only community-dwelling elderly and used pre-2015 versions of the AGS/Beers criteria [19][20][21][22][23][24] . The investigations conducted at the LTCIE included only non-profit institutions, less than 300 seniors and used the previous version of the 2015 AGS/Beers criteria [25][26][27] .…”

Evaluation of potentially inappropriate medications among hospitalized geriatric patients in tertiary care referral hospital using STOPP/START criteria

“…2 Use of multiple medications encompasses risk and benefits; for this reason appropriateness of drugs prescription and use are important indicators for assessing the quality of health for elderly. 4 Interpersonal variability in patient health, disability and disease usually increases considerably with ageing. It is a real challenge to administer proper therapy in elderly patients where there is significant potential for developing side-effects due to chronic use of drugs that can elicit strong systemic interactions.…”