GheOP³S tool and START/STOPP criteria version 2 for screening of potentially inappropriate medications and omissions in nursing home residents

Abstract

Rationale, aims, and objective: There is limited information about the comparative effectiveness of the START/STOPP (Screening Tool of Older Person's Prescriptions/Screening Tool to Alert doctors to Right Treatment) criteria and the Ghent Older People's Prescriptions community Pharmacy Screening tool (GheOP 3 S tool) for the screening of potentially inappropriate prescribing (PIP) in the geriatric population. Considering this, the aim of this study was to compare the ability of the START/STOPP criteria and GheOP 3 S tool to identify the PIP and potential prescribing omissions (PPOs) among elderly patients visiting their primary care physician.Methods: This is a retrospective observational study where a total of 422 subjects were included. The Charlson Co-morbidity Index (CCI) and the Medicines Comorbidity Index (MCI) for older people were used to determine the co-morbidity status. The user's diagnosis and medications prescribed were analysed with the START/STOPP criteria and GheOP 3 S tool. The Wilcoxon signed rank test was used to compare these criteria. The statistical relationship between the occurrence of PIP and users' age, the number of medication prescribed, the number of diagnoses, CCI, and MCI was determined with one-tailed bivariate correlation. Results:The START/STOPP criteria detected 843 PIPs and 1067 PPOs, while the GheOP 3 S tool detected 936 PIPs and 202 PPOs. The GheOP 3 S tool detected significantly more PIPs than did the STOPP criteria (P = 0.003). A significantly higher number of PPOs were detected with the START criterion (P < 0.0001). The results obtained with the START/STOPP criteria positively correlated with mentioned variables. Oppositely, there is a negative correlation between the results obtained with the GheOP 3 S tool and age. Still, the positive correlation could be found with the rest of the variables. Conclusion:The results of this study indicate that both tested tools demonstrated efficiency to detect PIPs and PPOs. The GheOP 3 S tool detected significantly more PIPs than did the STOPP criteria. On the other hand, the START criteria performed much better for the screening of PPOs.

<p>Medication Evaluation in Portuguese Elderly Patients According to Beers, STOPP/START Criteria and EU(7)-PIM List – An Exploratory Study</p>

“…These results are in agreement with those obtained in other similar studies carried out in Portugal and other European countries. 5,[29][30][31]33,38,41 In our study, in contrast to the others performed in Portugal, alprazolam and lorazepam were the two drugs most commonly prescribed as PIMs. In the study performed in pharmacies in Lisbon, diazepam and ticlopidine were the drugs associated with inappropriateness.…”

“…A study performed in elderly patients that visited their primary care physician showed that the absence of antiplatelet therapy was, also, a highly ranked PPO based on START criteria. 38 Another important group with omissions was the musculoskeletal system medication, but in our study, it was not attributed to the absence of vitamin D, rather to the absence of a bone anti-resorptive or anabolic therapy, in contrast to the study performed in nursing homes located in the region of Lisbon and Alentejo. 30 In the analysis of medical data, we did not detect any contraindication to the use of this class of drugs.…”

“…36 The drugs most frequently associated with inappropriate prescribing are antiplatelet agents with over-prescribing and omission, and benzodiazepines in prolonged use. 37,38 In addition, the long-term use of non-steroidal anti-inflammatory drugs has also been identified by applying the STOPP criteria. 6 In Portugal, a study about institutionalized people found a total of 484 drugrelated problems (DRP) in 31 elderly patients (median: 15 DRP/ patient).…”

“…30 In this context, it is important to mention that the average consumption of these two drug classes in Portugal is higher than in most European countries, 32 having potential consequences on the frail elderly. 33,38,44 The Beers criteria version of 2015 include the table "for Non-Anti-Infective Medications That Should Be Avoided or Have Their Dosage reduced with Varying Levels of Kidney Function in Older Adults, "25 but we did not assess patients in this context. However, we detected cases of patients taking drugs from this table, but there was no registration of creatinine clearance values in their clinical records and therefore it was not possible to assess whether the use of these drugs was or not potentially inappropriate.…”

Ghent Older People’s Prescriptions Community Pharmacy Screening (GheOP3S)-Tool Version 2: Update of a Tool to Detect Drug-Related Problems in Older People in Primary Care

“…Recent research has demonstrated a high PIP prevalence among older patients in primary care when medication reviews were performed with the GheOP 3 S-tool [23][24][25][26][27][28]. A potential impact on the number of potentially inappropriate medications and the anticholinergic/sedative medication burden was shown after multidisciplinary medication reviews with the GheOP 3 S-tool [25,26].…”