PS-091 Detection of inappropriate prescriptions for elderly comorbid patients according to STOPP/START criteria

Abstract

Background Inappropriate prescribing is highly prevalent in older people and has become a global healthcare concern. Purpose To detect inappropriate prescriptions for patients hospitalised in the Internal Medicine Ward according to STOPP/START criteria. To define the profile of patients who would benefit more from a pharmaceutical intervention. Materials and methods Observational and retrospective study of drugs prescribed to patients who were admitted and discharged from the Internal Medicine Ward of a second-level university hospital from October 2012 to February 2013. Patients were over the age of 65 and prescribed ≥5 drugs. The data were obtained from the patients’ medical records. STOPP and START criteria were applied to the drugs prescribed upon hospital admission and discharge. Results A group of 50 patients were studied at the time. The average age was: 80.4 (65–96). According to STOPP/START criteria 32 patients (64%) with inappropriate prescriptions were detected upon hospital admission and 18 (36%) upon hospital discharge. Regarding the age of the sample group, patients were classified into the following groups: 65–70 years old (8%), 71–80 years old (48%), 81–90 years old (30%), >90 (12%). According to STOPP criteria there were 45 non-recommended prescriptions upon hospital admission and 21 upon hospital discharge: NSAIDs with mild/severe hypertension (15% admission, 19% discharge) and duplicate drug class prescriptions (13% admission, 9% discharge). According to START criteria there were 59 cases upon hospital admission in which a non-prescribed drug had to be added and 30 on discharge, pointing out: ACE inhibitors in chronic heart failure (14% admission, 30% discharge) and ACE inhibitors or ARBsII in diabetes with nephropathy (12% admission, 13% discharge). Conclusions There was a high percentage of patients with inappropriate prescriptions. 48% of inappropriate prescriptions were corrected according to STOPP criteria and 53% according to START criteria during hospitalisation. As described by Sevilla-Sánchez et al (2012) the cardiovascular system group of medicines was the most frequently inappropriately prescribed. Patients between 81–90 years old would benefit more from a pharmaceutical intervention. As Lee et al (2013) prove, START/STOPP criteria can help doctors and pharmacists to prescribe properly in clinical practice. No conflict of interest.