Potentially inappropriate prescribing and associated factors in elderly patients at hospital discharge in Brazil: a cross-sectional study

Abstract

Background The Screening Tool of Older Persons' Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) criteria is used to identify instances of potentially inappropriate prescribing in a patient's medication regimen. Objective To determine the prevalence and predictors of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) among elderly patients at hospital discharge. Setting A university hospital medical clinic in Brazil. Method Discharge prescriptions were examined using the STOPP/START criteria. Subjects were inpatients aged ≥60 years receiving at least one medication prior to hospitalization and with a history of cardiovascular disease. The prevalence of PIMs and PPOs was determined and a multivariable binary regression analysis was performed to identify independent predictors associated with PIMs or PPOs. Main outcome measure Prevalence of PIMs and PPOs. Results Of the 230 subjects, 13.9% were prescribed at least one PIM. The most frequently prescribed PIMs were glibenclamide or chlorpropamide prescribed for type 2 diabetes mellitus (31.0%), and aspirin at doses >150 mg/day (14.3%). Ninety patients had at least one PPO (39.1%). The most prevalent PPOs were statins (29.8%) and antiplatelet therapy (13.7%) for diabetes mellitus when coexisting major cardiovascular risk factors were present. No predictors for PIMs were found. In contrast, diabetes was a risk factor while dyslipidaemia was a protective factor for PPOs. Conclusion PIMs and PPOs commonly occur with elderly people at hospital discharge. Diabetes and dyslipidaemia were significantly associated with PPOs. Our findings show the need for interventions to reduce potentially inappropriate prescribing, such as a pharmacist medication review process at hospital discharge.

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

“…Most study participants had at least one inadequate medicine prescription detected by the START/STOPP criteria. These findings are in line with other published works (Mori et al, 2017;Gallagher et al, 2011).…”

Factors associated with the use of potentially inappropriate medication by elderly patients prescribed at hospital discharge

“…Our study also helped to identify associated factors. The frequency of PIM use in our study was higher to the one recorded at a teaching hospital in São Paulo, Brazil 19 (13.9%) and to some in European countries, which varied between 23.5 and 48.0%. 12 , 20 , 21 A Brazilian study has also demonstrated a high prevalence of PIMs during hospital stay, 22 showing the importance of preventing and reducing the use of these medications from the moment the patient is admitted.…”

“…Outra contribuição do estudo foi a identificação dos fatores associados. A frequência de utilização de MPII foi superior à de investigação realizada em hospital de ensino de São Paulo 19 (13,9%) e às de países europeus, que variaram de 23,5 a 48%. 12 , 20 , 21 Um estudo brasileiro também demonstrou alta prevalência de uso de MPII durante a hospitalização, 22 evidenciando a importância de, desde a internação, buscar medidas para prevenir e reduzir o uso desses medicamentos.…”

Prevalence of Under-Prescription in Elderly Type 2 Diabetic Patients in the Primary Care Unit of a University Hospital

“…This was similar to previous studies that reported both types of medications were commonly omitted in elderly patients. 7,9,11,20,21 The prevalence of under-prescription of aspirin for primary prevention of CVD, which was the most common omitted medication in elderly type 2 diabetic patients in this study, was close to a previous study by Sabitha et al 22 The reason may be because that article used the criteria for under-prescription based on the Thai diabetes guideline of 2014. For the use of aspirin, the guideline gives a moderate recommendation based on evidence from previous studies that showed the benefit of aspirin in the primary prevention of CVD.…”