Potentially inappropriate prescribing in an Irish elderly population in primary care

Abstract

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Potentially inappropriate prescribing in older people is a well‐documented problem and has been associated with adverse drug reactions and hospitalization.• Beers' criteria, Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) are screening tools that have been formulated to help physicians and pharmacists identify potentially inappropriate prescribing and potential prescribing omissions.• The prevalence of potentially inappropriate prescribing and prescribing omissions in the elderly population presenting to hospital with acute illness is high according to STOPP and START criteria. WHAT THIS STUDY ADDS • Potential errors of prescribing and of omission of medicines are prevalent among medically stable older people in primary care.• Screening tools should be incorporated into the everyday practice of primary care doctors and community pharmacists as a means of preventing potential errors of prescribing commission and prescribing omission in older people.AIMS Screening tools have been formulated to identify potentially inappropriate prescribing (IP) in older people. Beers' criteria are the most widely used but have disadvantages when used in Europe. New IP screening tools called Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) have been developed to identify potential IP and potential prescribing omissions (PPOs). The aim was to measure the prevalence rates of potential IP and PPOs in primary care using Beers' criteria, STOPP and START.METHODS Case records of 1329 patients ≥65 years old from three general practices in one region of southern Ireland were studied. The mean age ± SD of the patients was 74.9 ± 6.4 years, 60.9% were female. Patients' current diagnoses and prescription medicines were reviewed and the Beers' criteria, STOPP and START tools applied.RESULTS The total number of medicines prescribed was 6684; median number of medicines per patient was five (range 1–19). Overall, Beers' criteria identified 286 potentially inappropriate prescriptions in 18.3% (243) of patients, whilst the corresponding IP rate identified by STOPP was 21.4% (284), in respect of 346 potentially inappropriate prescriptions. A total of 333 PPOs were identified in 22.7% (302) of patients using the START tool.CONCLUSION Potentially inappropriate drug prescribing and errors of drug omission are highly prevalent among older people living in the community. Prevention strategies should involve primary care doctors and community pharmacists.

What to give the patient who has everything? A qualitative study of prescribing for multimorbidity in primary care

“…7,8 However, prescribing 'appropriately' in multimorbidity is not always straightforward. 9,10 Guidelines exist for most common chronic diseases and offer benefits associated with the best available evidence, but adhering to guidelines in the management of a patient with multimorbidity almost invariably leads to multiple medications, resulting in increased risk of drug interactions, adverse effects, and poor adherence. 11,12 Furthermore, most guidelines do not consider patient preferences, quality of life, or the expected time to benefit.…”

“…14,36 Implications for research and practice Although GPs in this study provided logical reasons for their decisions, the potential negative outcomes associated with both polypharmacy and suboptimal disease management must be remembered and ways to support GPs' prescribing in multimorbidity are thus required. 9 In hospital specialties, there is an increasing trend towards multidisciplinary team (MDT) meetings, which operationalise collaborative decision making to deliver evidence-based yet patient-centred care. The potential for multidisciplinary review in primary care has been evaluated in trials such as PINCER, a pharmacist-led information technology intervention that reduced medication errors in general practice.…”

Potentially inappropriate prescribing in elderly population: A study in medicine out-patient department

“…7 To quantify potential inappropriate prescribing (IP) in older people, Beers' criteria were found to be most widely cited in the literature. 3 We explored the appropriateness of use of medicines for older patients from the perspectives of healthcare professionals and patients using Beers' criteria to quantify Potentially Inappropriate Medicines (PIM).…”

Proton pump inhibitor prescribing patterns in the UK: a primary care database study

“…30 Studies have showed that PPI use is associated with malabsorption of vitamins and 31 minerals 7,8 , an increased risk of infections, such as pneumonia 9 and enteric infection 10 , and 32 an increased fracture risk 11,12 . These potential side effects can be minimized through 33 appropriate prescription practices in terms of stepping down the dose or stopping long-term 34 treatment altogether. 35 As a consequence of this dramatic increase in PPI use and the associated potential risks, 36 clinical guidelines in the UK have recommended rationing the use of the PPI in the primary 37 care setting, either by stepping down the dose or stopping treatment all together 13 .…”