Criteria for high-risk medication use in Thai older patients

Winit-Watjana, Winit; Sakulrat, Parinya; Kespichayawattana, Jiraporn

doi:10.1016/j.archger.2007.06.006

Cited by 65 publications

(64 citation statements)

References 22 publications

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“…Diuretics were listed by four of the seven criteria, mainly as potentially inappropriate in combination with other drugs (e.g. NSAIDs, digoxin) or in patients with a history of gout [57-60]. …”

Section: Discussionmentioning

confidence: 99%

Drug - related emergency department visits by elderly patients presenting with non-specific complaints

Nickel

Ruedinger

Messmer

et al. 2013

Scand J Trauma Resusc Emerg Med

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BackgroundSince drug-related emergency department (ED) visits are common among older adults, the objectives of our study were to identify the frequency of drug-related problems (DRPs) among patients presenting to the ED with non-specific complaints (NSC), such as generalized weakness and to evaluate responsible drug classes.MethodsDelayed type cross-sectional diagnostic study with a prospective 30 day follow-up in the ED of the University Hospital Basel, Switzerland. From May 2007 until April 2009, all non-trauma patients presenting to the ED with an Emergency Severity Index (ESI) of 2 or 3 were screened and included, if they presented with non-specific complaints. After having obtained complete 30-day follow-up, two outcome assessors reviewed all available information, judged whether the initial presentation was a DRP and compared their judgment with the initial ED diagnosis. Acute morbidity (“serious condition”) was allocated to individual cases according to predefined criteria.ResultsThe study population consisted of 633 patients with NSC. Median age was 81 years (IQR 72/87), and the mean Charlson comorbidity index was 2.5 (IQR 1/4). DRPs were identified in 77 of the 633 cases (12.2%). At the initial assessment, only 40% of the DRPs were correctly identified. 64 of the 77 identified DRPs (83%) fulfilled the criteria “serious condition”. Polypharmacy and certain drug classes (thiazides, antidepressants, benzodiazepines, anticonvulsants) were associated with DRPs.ConclusionElderly patients with non-specific complaints need to be screened systematically for drug-related problems.Trial RegistrationClinicalTrials.gov: NCT00920491

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Section: Discussionmentioning

confidence: 99%

Drug - related emergency department visits by elderly patients presenting with non-specific complaints

Nickel

Ruedinger

Messmer

et al. 2013

Scand J Trauma Resusc Emerg Med

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“…The NORGEP list of 36 explicit criteria for potential pharmacological inappropriateness for general practitioners' prescribing practice, addresses drugs, drug doses and drug-drug interactions. The Italian list, the CRIteria to assess appropriate Medication use among Elderly complex patients (CRIME) [72], and the Thailand explicit criteria for high-risk medications, have also been proposed [73]. Countryspecific criteria that consider specific clinical environments and drugs may lead to a more comprehensive and useful tool, which may be useful for optimizing drug safety in frail older people from that country.…”

Section: Review -Gnjidic and Hilmermentioning

confidence: 99%

Use of Potentially Inappropriate Medications in the Care of Frail Older People

Gnjidic

Hilmer²

2010

Aging Health

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Achieving safe prescribing in frail older people is difficult owing to age-related physiological changes, multiple comorbidities, multiple medication use and a higher risk of adverse drug events (ADEs). Among people aged 65 years and over, 7–25% are frail. While frailty is recognized as a major public health problem, there is a lack of consensus on the definition of frailty and validated tools that can be used to assess the effects of frailty on pharmacological response in old age. Frail individuals are at higher risk of adverse clinical outcomes, such as hospitalization, falls, disability and mortality. There is also a lack of consensus on the definition of inappropriate medications. Inappropriate medication use is a major contributor to the risk of ADEs in frail older people. Therefore, development and implementation of tools to optimize appropriate use of medications is necessary for the medical care of frail older people.

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“…As a result, at least 13 other explicit screening tools have been developed, many of which are specific to the country for which they were developed . Many different clinicians including pharmacists, geriatricians, nurse practitioners, internists and researchers have used these different sets of explicit criteria to assess PIP across different healthcare settings and jurisdictions . The 2012 iteration of the Beers criteria has addressed some, but not all of the criticisms listed above…”

Section: What Is Known and Objectivementioning

confidence: 99%

Application of the STOPP/START criteria: a systematic review of the prevalence of potentially inappropriate prescribing in older adults, and evidence of clinical, humanistic and economic impact

et al. 2013

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of older person's potentially inappropriate prescriptions, screening tool to alert doctors to the right treatment SUMMARYWhat is known and Objective: Potentially inappropriate prescribing (PIP) has significant clinical, humanistic and economic impacts. Identifying PIP in older adults may reduce their burden of adverse drug events. Tools with explicit criteria are being developed to screen for PIP in this population. These tools vary in their ability to identify PIP in specific care settings and jurisdictions due to such factors as local prescribing practices and formularies. One promising set of screening tools are the STOPP (Screening Tool of Older Person's potentially inappropriate Prescriptions) and START (Screening Tool of Alert doctors to the Right Treatment) criteria. We conducted a systematic review of research studies that describe the application of the STOPP/START criteria and examined the evidence of the impact of STOPP/START on clinical, humanistic and economic outcomes in older adults. Methods: We performed a systematic review of studies from relevant biomedical databases and grey literature sources published from January 2007 to January 2012. We searched citation and reference lists and contacted content experts to identify additional studies. Two authors independently selected studies using a predefined protocol. We did not restrict selection to particular study designs; however, non-English studies were excluded during the selection process. Independent extraction of articles by two authors used predefined data fields. For randomized controlled trials and observational studies comparing STOPP/START to other explicit criteria, we assessed risk of bias using an adapted tool. Results and Discussion: We included 13 studies: a single randomized controlled trial and 12 observational studies. We performed a descriptive analysis as heterogeneity of study populations, interventions and study design precluded metaanalysis. All observational studies reported the prevalence of PIP; however, the application of the criteria was not consistent across all studies. Seven of the observational studies compared STOPP/ START with other explicit criteria. The STOPP/START criteria were reported to be more sensitive than the more-frequentlycited Beers criteria in six studies, but less sensitive than a set of criteria developed in Australia. The STOPP criteria identified more medications associated with adverse drug events than the 2002 version of the Beers criteria. Patients with PIP, as identified by STOPP, had an 85% increased risk of adverse drug events in one study (OR = 1Á85, 95% CI: 1Á51-2Á26; P < 0Á001). There was limited evidence that the application of STOPP/START criteria optimized prescribing. Research involving the application of STOPP/START on the impact on the quality of life was not found. The direct costs of PIP were documented in three studies from Ireland, but more extensive analyses on the economic impact or studies from other jurisdictions were not found. What is new and Conclusion: The STOPP/START c...

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Criteria for high-risk medication use in Thai older patients

Cited by 65 publications

References 22 publications

Drug - related emergency department visits by elderly patients presenting with non-specific complaints

Drug - related emergency department visits by elderly patients presenting with non-specific complaints

Use of Potentially Inappropriate Medications in the Care of Frail Older People

Application of the STOPP/START criteria: a systematic review of the prevalence of potentially inappropriate prescribing in older adults, and evidence of clinical, humanistic and economic impact

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