Ability to detect potentially inappropriate prescribing in older patients: comparative analysis between PIM-Check and STOPP/STARTv2

Abstract

Purpose Potentially inappropriate prescribing (PIP) is a source of preventable adverse drug events. The objective of this study was a comparative analysis (quantitative and qualitative) between two tools used to detect PIP, PIM-Check and STOPP/START. Methods First, a qualitative analysis (QAC) was conducted to evaluate the concordance between the criteria, which constitute PIM-Check and the gold standard STOPP/START. Second, a retrospective comparative and observational study was performed on the list of treatment at the admission of 50 older patients hospitalized in an acute geriatric ward of a university hospital in Switzerland in 2016 using both tools. Results The QAC has shown that 50% (57 criteria) of STOPP/START criteria are fully or partially concordant with those of PIM-Check. The retrospective study was performed on 50 patients aged 87 years, suffering from 5 co-morbidities (min–max 1–11) and treated by of 8 drugs (min–max 2–16), as medians. The prevalence of the detected PIP was 80% by PIM-Check and 90% by STOPP/START. Medication review shows that 4.2 PIP per patient were detected by PIM-Check and 3.5 PIP by STOPP/START among which 1.9 PIP was commonly detected by both tools, as means. PIM-Check detected more PIP related to cardiology, angiology, nephrology, and endocrinology in older patients but missed the PIP related to geriatric syndromes (e.g., fall, dementia, Alzheimer) detected by STOPP/START. Conclusions By using PIM-Check in geriatric settings, some PIP will not be detected. It is considered as a limitation for this tool in this frail population but brings a certain complementarity in other areas of therapy not covered by STOPP/START.

Impact of Pharmaceutical Interventions in Hospitalized Patients: A Comparative Study Between Clinical Pharmacists and an Explicit Criteria-Based Tool

“…The available literature evaluating the use of PIM-Check includes 3 studies, among which 2 studies compared retrospectively the rate of detection of prescribing errors between 2 tools, PIM-Check and STOPP/START. The first was conducted in a geriatric population 28 and the second in internal medicine settings. 29 The third study evaluated the variation of inappropriate prescribing, during hospitalization, using PIM-Check.…”

“…This could be explained by the fact that PIM-Check tool targets preferentially underprescribing (prescribing omission) and thus tends by design to recommend treatment initiation. 28 …”

Impact of Pharmaceutical Interventions with STOPP/START and PIM-Check in Older Hospitalized Patients: A Randomized Controlled Trial

“…The number of interventions at admission was higher in the PIM-Check arm, but with a lower acceptance rate than STOPP/START, which could reflect the more specific recommendations of STOPP/START towards older patients. Yet, the high number of PIM-Check recommendations may bring a certain complementarity in other areas of pharmacotherapy not covered in the STOPP/START criteria [ 20 ].…”

“…The sample size has been calculated based on the expected prevalence and reduction of PIPs. According to STOPP/START criteria, prevalence of PIPs of 90% has been measured in the same setting of this study (ACE at Lausanne University Hospital in Switzerland) [ 20 ]. A reduction of 22% of the prevalence of patients with at least one PIP at discharge after intervention was measured using STOPP criteria in older hospitalized patients in Switzerland [ 21 ].…”

Pharmacological Risk Assessment Among Older Patients with Polypharmacy Using the Clinical Decision Support System Janusmed Risk Profile: A Cross-Sectional Register Study

“…The number of medicines used by patients increases the risk for potentially inappropriate prescribing and potential prescribing omissions. This is especially a challenge for older patients who are also more prone to experience adverse effects [ 3 , 4 ]. Of note, in many patient populations, polypharmacy is a necessity and patients benefit, for example multimorbid patients or patients with conditions typically requiring treatment with several substances such as hypertension and or diabetes mellitus [ 5 ].…”