Causes and factors associated with inappropriate prescribing in older patients identified at hospital admission: application of the criteria STOP-START

Abstract

Background Inappropriate medication use is a major patient safety concern, especially for the older population Purpose To analyse the causes of potentially inappropriate prescribing (IP) in patients over 64 admitted to the hospital and to determine factors associated with their presence in the treatment. Materials and methods Observational study was conducted in a referral area hospital. The authors included all patients over 64 admitted to the hospital in the last quarter of 2009, and selected a representative sample randomised and prospectively. Inappropriate prescription (IP) was considered according to STOP-START criteria1 as well as the low therapeutic value (LTV) prescriptions. Prevalence and causes of IP and the factors associated were determined. All tests were performed using SPSS version15.0. Results In the study were included 382 patients with a mean age of 77,7 years. 58,1% of patients had at least one IP. After applying the STOP-START criteria, IP were detected in 45,8% of patients and in and in 23,8% LTV prescriptions. Common IP categories were long-term use of potent opioids for treatment of mild to moderate pain (18.8% of patients), prescribing omission of metformin in patients with type 2 diabetes mellitus (17, 1% of patients) and prescribing omission of fibre supplements in chronic symptomatic diverticulosis and constipation (16.6% of patients). These three cases comprised 35.3% of the IP and affected 52.6% of patients. Factors associated with a higher prevalence of inappropriate prescriptions by STOPP criteria were musculoskeletal diseases, autoimmune or CKD and polypharmacy. According to START criteria the factors associated were chronic heart disease, and symptomatic peripheral arterial disease or diabetes with visceral injury. Conclusions There is a high prevalence of IP for older patients. Should be systematised the detection of this kind of prescriptions giving preference to the polypharmacy and with certain types of comorbidity.

The utility of the records medical: factors associated with the medication errors in chronic disease

“…Medication-related problem: analysis of high risk medication 16 , low therapeutic margin 17 , renal risk 18 , inappropriate medication, 19 and fall risk 20 .…”