CP-030 Assessment of medical care for older patients in an acute geriatric department with the stopp/start criteria

Abstract

BackgroundSTOPP and START criteria were developed to identify potentially inappropriate prescription (PIP) and potentially prescribing omission (PPO), and to improve the use of medication in older people.PurposeThe aim of this study was to evaluate the medical care for elderly patients in an acute geriatric department with the STOPP and START criteria.Material and methodsThis study included patients admitted to the acute geriatric department in an academic hospital from July to October 2015. Using pre-admission treatment, a pharmacist used STOPP and START criteria version 2 to identify PIPs and PPOs. After the patient’s discharge, a geriatrician and a pharmacist assessed how many STOPP and START criteria were followed according to the discharge prescription. The reason for not following STOPP/START criteria was investigated using clinical records.ResultsAmong 81 patients included, 224 PIPs were identified according to STOPP criteria, of which 168 (75%) were followed by the geriatricians. Among 56 cases of non-adherence to STOPP criteria, 50 cases (90%) presented a justified reason for this decision. Among 262 inappropriate prescriptions identified by geriatricians, 94 (36%) prescriptions were supplementary and not identified by STOPP criteria. Supplementary drugs stopped the most by geriatricians were drugs related to the cardiovascular system (n=28), mostly because the treatment was ineffective (n=7).According to START criteria, 90 PPOs were identified, of which 56 (62%) were followed by the geriatricians. Among 34 cases of non-adherence to START criteria, 27 cases (79%) presented a justified reason for this decision. Among 273 omission prescriptions identified by geriatricians, 217 prescriptions were supplementary and not identified by START criteria. The drugs started most by geriatricians were drugs related to the central nervous system (n=79), mostly because patients presented moderate pain (n=36).ConclusionIn this study, PIP and PPO STOPP and START criteria were usually followed by geriatricians. The reasons for not following the criteria were usually justified. However, cases of non-adherence to START criteria were more important than cases of non-adherence to STOPP criteria. In these cases, geriatricians added more drugs than the START criteria. More studies about following these criteria should be performed in older patients admitted to hospital, especially in others wards, without geriatricians.No conflict of interest

Reviewing Potentially Inappropriate Medication in Hospitalized Patients Over 65 Using Explicit Criteria: A Systematic Literature Review

“… 71.4% of the recommendations generated by the CPEO were accepted and 92.5% of the pharmacist recommendation were accepted. 2 Kadri, 2017 39 France Prospective study 81 Patients STOPP/START Pharmacist assessed the prescription and the PIM were documented to the physician in the patient records. After discharge both the geriatrician and the pharmacist investigated the cases in which STOPP/START recommendations were not approved.…”

“… 27 Moreover, there was one pilot study, 36 three before-and-after studies, 28–30 four observational studies, 37 , 38–42 and nine interventional studies. 31–35 , 38 , 39 . Approximately 16,093 patients were included in the studies.…”

“…Most studies used various versions of the STOPP/START tool, which was originally developed in Ireland. 21 , 22 , 27 , 29 , 33 , 37 , 39 , 47 This tool was used in studies conducted in Ireland, Belgium, India, Switzerland, Spain, and France. Beers criteria were implemented in six studies conducted in the United States, Belgium, Vietnam, Italy, Iran and Taiwan.…”

“…Ten studies applied explicit tools on admission, 21 , 22 , 26 , 28 , 29 , 31–33 , 35 , 40 nine studies during the hospital stay, 20 , 23 , 24 , 30 , 34 , 36 , 37 , 46 , 47 and several studies did not report the stage of hospitalization in which the HCP used the tools. 25 , 38 , 39 , 41–45 …”

“…In eight studies, the PIM was detected using explicit tools and the recommendations were communicated orally to the attending physician, 20 , 21 , 24 , 26 , 33 , 35 , 36 , 44 while in four studies, the PIM was communicated in written form. 27 , 39 , 41 , 42 Two studies communicated the recommendation verbally and written to the attending physician. 31 , 32 Two studies used a computerized system to review PIM and communicated with the physician through an alert system, 28 , 45 while in the other two studies, the computerized system and was assessed by the hospital pharmacist to detect PIM and the results communicated verbally to the attending physician.…”