Improving Elderly Patients’ Medication Appropriateness in an Internal Medicine Ward: Application of the STOPP/START Criteria
DOI:
https://doi.org/10.24950/O/290/19/2/2020Keywords:
Aged, Drug-Related Side Effects and Adverse Reactions, Hospitalization, Inappropriate Prescribing, Polypharmacy.Abstract
Introduction: In elderly people, polypharmacy and inappropriate prescribing are prevalent and associated with adverse events. STOPP/START criteria are a tool aiming to improve elderly medication appropriateness that has shown good validity, interrater reliability and applicability.
Our aim was to evaluate the impact of the application of STOPP/START criteria version 2 to the prescription of hospitalized elderly patients.
Methods: A prospective, single-centre study carried out in a tertiary internal medicine ward. Patients admitted with 65 years or more and with 5 or more medications were randomized to receive either usual physician and pharmacist care (control) or providing the patient ́s attending medical team, within the first 72 hours, a pop-up recommendation indicating potentially inappropriate medications (PIM) and potentially prescribing omissions (PPO) as a result of the application of the STOPP/START version 2 criteria (intervention). Statistical analysis done with SPSS version 23 considered a p <0.05.
Results: 156 patients were included and random- ized, and 64 on the intervention group and 62 on the con- trol group were analysed. The team observed an average PIM and PPO reduction of 49% and 31% in the intervention group versus 13% and 0% in the control group (p = 0.01). There was an average acceptance of 63% for STOPP and 40% for START criteria recommendations. In the overall population the team found a prevalence of polypharmacy of 21% and of inappropriate prescription (at least one PIM) of 75.4% and identified a total of 230 PIM and 153 PPO.
Conclusion: The team reports a high prevalence of polypharmacy and inappropriate prescription among Portuguese elderly patients admitted to an internal medicine ward. The latter was significantly reduced using pop-up recommendations reporting the application of STOPP/START version 2 criteria within 72 hours of admission.
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