Impact of hospitalization on potentially inappropriate prescribing: a cross-sectional study in an acute geriatric hospital in Lithuania

Grina, Donatas; Karpavičiūtė, Justina; Minkutė, Rima; Briedis, Vitalis

doi:10.1007/s11096-020-01035-y

Cited by 8 publications

(11 citation statements)

References 20 publications

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“…The study compared the prevalence and pattern Coagulation System "Aspirin plus clopidogrel as secondary stroke prevention, unless the patient has a coronary stent(s) inserted in the previous 12 months or concurrent acute coronary syndrome or has a high grade symptomatic carotid arterial stenosis" of discharge PIPs before and after the intervention. Before the intervention, the prevalence of PIMs at discharge was found to be 27% which is lower than what was found elsewhere [4,29,30]. Consistent with other studies, the most common PIM was related to medications that increases the risk of falls in older adults [31][32][33][34][35].…”

Section: Discussionsupporting

confidence: 79%

“…The study compared the prevalence and pattern of discharge PIPs before and after the intervention. Before the intervention, the prevalence of PIMs at discharge was found to be 27% which is lower than what was found elsewhere [ 4 , 29 , 30 ]. Consistent with other studies, the most common PIM was related to medications that increases the risk of falls in older adults [ 31 – 35 ].…”

Section: Discussioncontrasting

confidence: 67%

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The impact of a multifaceted intervention to reduce potentially inappropriate prescribing among discharged older adults: a before-and-after study

Akkawi

Mohamed

Aris

2020

J of Pharm Policy and Pract

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Background: Potentially inappropriate prescribing (PIP) is associated with the incidence of adverse drug reactions, drug-related hospitalization and other negative outcomes in older adults. After hospitalization, older adults might be discharged with several types of PIPs. Studies have found that the lack of healthcare professionals' (HCPs) knowledge regarding PIP is one of the major contributing factors in this issue. The purpose of this study is to investigate the impact of a multifaceted intervention on physicians' and clinical pharmacists' behavior regarding potentially inappropriate medication (PIM) and potential prescribing omission (PPO) among hospitalized older adults. Methods: This is a before-and-after study that took place in a tertiary Malaysian hospital. Discharge medications of patients ≥65 years old were reviewed to identify PIMs/PPOs using version 2 of the STOPP/START criteria. The prevalence and pattern of PIM/PPO before and after the intervention were compared. The intervention targeted the physicians and clinical pharmacists and it consisted of academic detailing and a newly developed smartphone application (app). Results: The study involved 240 patients before (control group) and 240 patients after the intervention. The prevalence of PIM was 22% and 27% before and after the intervention, respectively (P = 0.213). The prevalence of PPO in the intervention group was significantly lower than that in the control group (42% Vs. 53.3%); P = 0.014. This difference remained statistically significant after controlling for other variables (P = 0.015). The intervention was effective in reducing the two most common PPOs; the omission of vitamin D supplements in patients with a history of falls (P = 0.001) and the omission of angiotensin converting enzyme inhibitor in patients with coronary artery disease (P = 0.03). Conclusions: The smartphone app coupled with academic detailing was effective in reducing the prevalence of PPO at discharge. However, it did not significantly affect the prevalence or pattern of PIM.

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Section: Discussionsupporting

confidence: 79%

Section: Discussioncontrasting

confidence: 67%

The impact of a multifaceted intervention to reduce potentially inappropriate prescribing among discharged older adults: a before-and-after study

Akkawi

Mohamed

Aris

2020

J of Pharm Policy and Pract

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“…The higher rates of PIM use in older inpatients may indicate higher comorbidities and medication burden, while higher PPOs in community‐dwelling older adults may reflect less frequent medication reviews compared to inpatient care. In comparison with NZ studies, international studies using STOPP/START criteria, have reported much higher rates of inappropriate medications (up to 90%) 10 and prescribing omissions (up to 96%) 11 . This suggests that a well‐integrated system is needed to ensure the safe use of medicines and reduce medicine‐related harm in this vulnerable population.…”

Section: Discussionmentioning

confidence: 98%

Potentially inappropriate medications and potential prescribing omissions in hospitalised older adults in New Zealand: A retrospective study

Shalabi

Chan

et al. 2023

Australas J Ageing

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ObjectiveMedication errors can have detrimental effects on patient outcomes, yet there are limited data on the prevalence of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) among older adult inpatients in New Zealand (NZ). This study investigated exposure to PIMs and PPOs in older adults in a New Zealand hospital.MethodsElectronic medical records of 846 older adults (≥ 65 years) discharged from the Auckland District Health Board between June 2020 and May 2021 were retrospectively reviewed to extract data on sociodemographic, medication and diagnostic information. STOPP/START version 2 was used to evaluate PIMs and PPOs on admission and discharge.ResultsThe mean age was 77.47 ± 8.12 years, and 51% were female. On admission, 48% had ≥1 PIMs and 40% had ≥1 PPOs. On discharge, 45% had ≥1 PIMs and 40% had ≥1 PPOs. Increasing age (adjusted odds ratio [AOR] = 1.02, 95% CI [confidence interval] 1.01, 1.04), number of medicines (AOR = 1.23, CI 1.17, 1.29) and 28‐day admission history (AOR = 1.58, CI 1.15, 2.18) were associated with higher odds of PIMs use on admission. At discharge, the number of medicines (AOR = 1.19, CI 1.13, 1.25) and history of readmission (AOR = 1.47, CI 1.08, 2.02) were associated with higher odds of PIMs. Female patients had higher odds of PPOs both on admission (AOR = 1.35, CI 1.02, 1.78) and discharge (AOR = 1.34, CI 1.01, 1.78). Māori, Asian and Pacific patients were more likely to have prescribing omissions compared to NZ Europeans.ConclusionsPrescribing omissions and inappropriate medications were common in older inpatients. There were differences observed between different ethnic groups, with NZ Europeans having fewer omissions than other ethnic groups. These findings highlight key opportunities for health‐care providers to improve medication use in older adults in NZ.

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“…A study conducted in a hospital setting in Lithuania where the Beers 2015 criteria, the STOPP v2 criteria, and the EU(7)-PIM list were applied at hospital admission and discharge found that the percentages of patients with at least one PIM were 44.7–59.2%, 67.1–71.1%, and 69.7–72.4%, respectively [ 18 ], different values from those obtained in our study, although there was also an increase in PIMs between admission and discharge. A study in people with dementia and cognitive impairment where the Beers criteria were applied showed a significant decrease in PIMs between hospital admission and discharge (96% on admission and 87% on discharge) [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Potentially Inappropriate Medication at Admission and at Discharge: A Geriatric Study in an Internal Medicine Service in Portugal

Perpétuo

Plácido

Aperta

et al. 2023

IJERPH

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Aging is associated with an increase in the prevalence of chronic diseases and polypharmacy, and with the prescription of potentially inappropriate medications (PIMs). This study aimed to analyze the variation in PIMs from hospital admission to discharge. A retrospective cohort study was conducted on inpatients of an internal medicine service. According to the Beers criteria, 80.7% of the patients had been prescribed at least one PIM at admission and 87.2% at discharge; metoclopramide was the most-prescribed PIM from admission to discharge, and acetylsalicylic acid was the most-deprescribed one. According to the STOPP criteria, 49.4% of patients had been prescribed at least one PIM at admission and 62.2% at discharge; quetiapine was the most-prescribed PIM from admission to discharge, and captopril was the most-deprescribed one. According to the EU(7)-PIM list, 51.3% of patients had been prescribed at least one PIM at admission and 70.3% at discharge, and bisacodyl was the most-prescribed PIM from admission to discharge and propranolol the most-deprescribed one. It was found that the number of PIMs at discharge was higher than at admission, suggesting the need to develop a guide with adapted criteria to be applied in an internal medicine service.

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Impact of hospitalization on potentially inappropriate prescribing: a cross-sectional study in an acute geriatric hospital in Lithuania

Cited by 8 publications

References 20 publications

The impact of a multifaceted intervention to reduce potentially inappropriate prescribing among discharged older adults: a before-and-after study

The impact of a multifaceted intervention to reduce potentially inappropriate prescribing among discharged older adults: a before-and-after study

Potentially inappropriate medications and potential prescribing omissions in hospitalised older adults in New Zealand: A retrospective study

Potentially Inappropriate Medication at Admission and at Discharge: A Geriatric Study in an Internal Medicine Service in Portugal

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