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

Perpétuo, Carla; Plácido, Ana I.; Aperta, Jorge; Figueiras, Adolfo; Herdeiro, María Teresa; Roque, Fátima

doi:10.3390/ijerph20064955

Cited by 2 publications

(4 citation statements)

References 33 publications

(47 reference statements)

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“…In this direction, several studies have reported that the inadequate prescription of BZD, according to STOPP criteria, are found among the most frequent PIM [ 31 , 32 , 38 ]. However, other studies did not find use of BZD as any of the most detected PIM [ 26 ], probably due to the struggles in determining prescription adequacy retrospectively. Interestingly, through our clinical committee review process, we have been able to reduce the prescription of BZD between 63 and 75%, depending on the criteria, in the internal medicine and the geriatric services.…”

Section: Discussionmentioning

confidence: 96%

“…The optimization of medical prescription in older patients, with the final goal of diminishing PIDP incidence, is one of the main concerns among clinical teams. In fact, several studies retrospectively comparing the incidence of PIDP between patients’ admission and discharge have been reported in the last years [ 26 – 30 ]. Nevertheless, they were performed in a retrospective manner and provide contradictory results.…”

Section: Discussionmentioning

confidence: 99%

“…Some publications indicate that the lack of clinical intervention during hospitalization causes an increase in the total number of PIDP. For instance, Perpetuo et al reported that, at admission, 49.4% of patients presented at least one STOPP criteria and this value augmented up to 62.2% at discharge [ 26 ]. Similar results were published by Abukhalil et al, reporting an increase of 8.1% between admission and discharge, in a younger patients’ cohort with lower degree of polypharmacy and comorbidity Charlson Index compared to our cohort [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

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Multidisciplinary medication review during older patient hospitalization according to STOPP/START criteria reduces potentially inappropriate prescriptions: MoPIM cohort study

Ortonobes,

Herranz,

Lleal

et al. 2024

BMC Geriatr

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Purpose Multimorbidity and polypharmacy in older adults converts the detection and adequacy of potentially inappropriate drug prescriptions (PIDP) in a healthcare priority. The objectives of this study are to describe the clinical decisions taken after the identification of PIDP by clinical pharmacists, using STOPP/START criteria, and to evaluate the degree of accomplishment of these decisions. Methods Multicenter, prospective, non-comparative cohort study in patients aged 65 and older, hospitalized because of an exacerbation of their chronic conditions. Each possible PIDP was manually identified by the clinical pharmacist at admission and an initial decision was taken by a multidisciplinary clinical committee. At discharge, criteria were re-applied and final decisions recorded. Results From all patients (n = 674), 493 (73.1%) presented at least one STOPP criteria at admission, significantly reduced up to 258 (38.3%) at discharge. A similar trend was observed for START criteria (36.7% vs. 15.7%). Regarding the top 10 most prevalent STOPP criteria, the clinical committee initially agreed to withdraw 257 (34.2%) prescriptions and to modify 93 (12.4%) prescriptions. However, the evaluation of final clinical decisions revealed that 503 (67.0%) of those STOPP criteria were ultimately amended. For the top 10 START criteria associated PIDP, the committee decided to initiate 149 (51.7%) prescriptions, while a total of 198 (68.8%) were finally introduced at discharge. Conclusions The clinical committee, through a pharmacotherapy review, succeeded in identifying and reducing the degree of prescription inadequacy, for both STOPP and START criteria, in older patients with high degree of multimorbidity and polypharmacy. Trial Registration NCT02830425.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Multidisciplinary medication review during older patient hospitalization according to STOPP/START criteria reduces potentially inappropriate prescriptions: MoPIM cohort study

Ortonobes,

Herranz,

Lleal

et al. 2024

BMC Geriatr

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“…Regarding nursing home residents, PIM was observed in 86.4% [ 30 ]. Recently, one study also found that the number of PIMs at discharge was higher than at admission in Portuguese geriatric inpatients of an internal medicine service [ 31 ].…”

Section: Introductionmentioning

confidence: 99%

Comparing AGS Beers 2019, STOPP version 2, and EU(7)-PIM list in Portuguese older adults in primary health care

Rodrigues,

Herdeiro,

Mateos-Campos

et al. 2024

Eur J Clin Pharmacol

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Purpose This study aims to identify PIM prevalence in older adults according to the 2019 Beers criteria, Screening Tool of Older Person’s Prescriptions version 2 (STOPP v2) criteria, and the Portuguese EU(7)-PIM list and also to analyze the concordance between these criteria. Methods A retrospective study was conducted among 1200 Portuguese older adults (≥ 65 years old), users of primary health care. Demographic, clinical, and pharmacological data were collected concerning the period between April 2021 and August 2022. A comparative analysis was performed between the three PIM identification criteria, and the concordance was determined according to the Lin concordance correlation coefficient. Results The mean age was 76.3 (SD 7.7) years old and 57.6% of the older adults were females. Our findings indicate varying prevalence rates among these criteria with 63.8% (95% CI 61.0–66.6%), 66.8% (95% CI 64.1–69.5%), and 50.1% (95% CI 47.2–53.0%) of the older adults take at least one PIM according to the EU(7)-PIM list, Beers 2019, and STOPP v2 criteria, respectively. The highest prevalence observed was for proton pump inhibitors according to EU(7)-PIM list (30.1%, 95% CI 27.6–32.9) and Beers criteria (30.1%, 95% CI 27.6–32.9) and alprazolam according to STOPP v2 criteria (10.1%, 95% CI 8.4–11.9%). A poor concordance between criteria was observed (< 0.834). The highest concordance coefficient was found between the EU(7)-PIM list and the Beers criteria (0.833), and the lowest between the EU(7)-PIM list and STOPP criteria (0.735). Conclusion This study reveals varying prevalence rates of PIM in older adults, as assessed by different criteria, and highlights the need for targeted interventions and improved prescribing practices. In the future, studies should focus on the occurrence of negative outcomes in older adults associated with PIM consumption.

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

Cited by 2 publications

References 33 publications

Multidisciplinary medication review during older patient hospitalization according to STOPP/START criteria reduces potentially inappropriate prescriptions: MoPIM cohort study

Multidisciplinary medication review during older patient hospitalization according to STOPP/START criteria reduces potentially inappropriate prescriptions: MoPIM cohort study

Comparing AGS Beers 2019, STOPP version 2, and EU(7)-PIM list in Portuguese older adults in primary health care

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