Inappropriate Prescribing in Older Hospitalized Adults: A Comparison of Medical Specialties

Juliano, Ana Carmen dos Santos Ribeiro Simoes; Lucchetti, Alessandra Lamas Granero; Silva, Jéssica Teixeira Santos da; Santos, Letícia Gomes; Nunes, Jéssica Borges Taranto; Fernandes, Guilherme Côrtes; Lucchetti, Giancarlo

doi:10.1111/jgs.15138

Cited by 19 publications

(20 citation statements)

References 29 publications

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“…The study population comprised patients discharged from a single medical unit in one hospital and therefore results may not be generalizable to other settings. However, the observed prevalence of PIMs and PPOs in our study is comparable to those reported by others in different patient groups .…”

Section: Discussionsupporting

confidence: 90%

“…The higher reported prevalence in the inpatient setting is likely a reflection of greater co‐morbidity and prescription medication burden. Our finding that 59.1% of the study population were subject to one or more PIMs is similar to the proportion reported by others applying version 2 of the STOPP criteria in the inpatient setting .…”

Section: Discussionsupporting

confidence: 90%

“…Published studies which have applied version 2 of the STOPP criteria report PIM prevalence of between 39.1% and 56.1% in older adults in the community and long-term care setting, and 42.1% to 88.5% in the inpatient setting [25][26][27][28][29][30][31][32][33][34]. The higher reported prevalence in the inpatient setting is likely a reflection of greater co-morbidity and prescription medication burden.…”

Section: Discussionmentioning

confidence: 99%

“…In recognition of changes in evidence-based treatment and recognition of the diminished clinical relevance for some criteria, an updated version (version 2) of the STOPP/START criteria were introduced in 2014 [24]. While the updated STOPP criteria have been used extensively to assess PIMs in older adults [25][26][27][28][29][30][31][32], there is limited data using the updated START criteria to assess prevalence of PPOs [33,34]. Additionally, little is known about the utility of the new criteria to predict clinically meaningful outcomes such as readmission rates and mortality [33].…”

Section: Introductionmentioning

confidence: 99%

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Hospital readmissions, mortality and potentially inappropriate prescribing: a retrospective study of older adults discharged from hospital

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Millar

McLay

2018

Brit J Clinical Pharma

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hospital readmissions, mortality and potentially inappropriate prescribing: a retrospective study of older adults discharged from hospital

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Millar

McLay

2018

Brit J Clinical Pharma

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“…There is an association between inappropriate prescribing in the elderly and mortality, need for additional healthcare services, adverse drug events, and decreased quality of life (3,4). Several studies were conducted to assess appropriate medication prescription among elderly in different settings including the community (5,6), primary care settings (7,8), nursing homes (9), and hospitals (10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Assessment of inappropriate medication use in Jordanian elderly hospitalized patients using 2015 Beers criteria

Bulatova¹,

Elayeh²,

Abdullah³

et al. 2019

tjgeri

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ASSESSMENT OF INAPPROPRIATE MEDICATION USE IN JORDANIAN ELDERLY HOSPITALIZED PATIENTS USING 2015 BEERS CRITERIA Introduction: Inappropriate prescribing in the elderly is associated with poor clinical outcomes. Using 2015 Beers criteria update, we aimed to evaluate the prevalence of inappropriate medication prescribing among elderly non-critically ill inpatients and to identify factors associated with inappropriate prescribing. Materials and Method: This cross-sectional study included patients aged 65 years and over admitted to the internal medicine and surgical wards. Using 2015 Beers criteria, we assessed potentially inappropriate medication prescribing, both prior to admission and during the hospital stay. Binary logistic regression analysis was used to assess the predictors of PIM. Results: Among 351 patients, the use of at least one PIM was identified in 29.3% of cases prior to admission, 98% of which continued to receive PIMs during the hospital stay. Additionally, at least one potentially inappropriate medication was identified in 47.2% of patients during the hospital stay. The most common PIMs prior to admission were proton pump inhibitors (26.2%), followed by alpha blockers (5.1%) and digoxin (4%). Proton pump inhibitors were also the most common PIMs in the hospital (42.5%), followed by alpha blockers (4.8%) and metoclopramide (4.3%). According to the binary logistic regression analysis, factors that significantly affected PIM prescription in the hospital were the number of drugs prescribed in the hospital (odds ratio 1.222, P=0.001) and medical ward admission (odds ratio 1.686, P=0.035). Conclusion: There is an alarmingly high prevalence of PIM use among Jordanian elderly patients, with polypharmacy being its major factor.

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Off‐label quetiapine prescribing in general hospital inpatients: an Australian experience

Brett

Anthony

Kamel

et al. 2020

Pharmacy Practice and Res

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Background Quetiapine is frequently prescribed off‐label in the community but little is known about the initiation and use of quetiapine in general (non‐psychiatry) hospital settings. Aim This study examined the extent of off‐label quetiapine prescribing and rates of initiation of quetiapine in a general inpatient population of an Australian inner city teaching hospital, as well as the frequency of communication with community prescribers following discharge. Methods A retrospective observational study was conducted of all patients admitted under all non‐psychiatric teams and prescribed quetiapine within a tertiary teaching hospital between 1 January 2011 and 31 December 2016. All quetiapine prescribing information was extracted from an electronic medication management system (EMMS) and medical records were reviewed for a random sample of 100 patients prescribed quetiapine. Results EMMS data indicated that 793 people were prescribed quetiapine over the study period. Quetiapine was most frequently prescribed once daily, with a median daily dose of 100 mg (interquartile range 37.5–200 mg). Eighty‐seven of the 100 medical records reviewed had corresponding discharge summaries, and potentially off‐label quetiapine prescribing was found in 48 people (55%); the most frequent off‐label indication was for agitation or delirium. Of the 33 people who had quetiapine initiated in hospital, 26 prescriptions (79%) were for off‐label indications. Of the 11 prescriptions (33%) continued at discharge, only three (27%) discharge summaries contained instructions to community prescribers regarding quetiapine. Conclusion Off‐label prescribing of quetiapine was common in this sample of inpatients, and senior hospital staff should remain cautious of quetiapine prescribing for indications where the evidence of harms and benefits remains unclear. Communication with community prescribers could also be improved to reduce the risk of conversion from intended short‐term off‐label use to longer‐term use.

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Inappropriate Prescribing in Older Hospitalized Adults: A Comparison of Medical Specialties

Abstract: This study demonstrates the high and growing prevalence of PIMs in the hospital environment, according to Beers and STOPP criteria. Educational measures and specific pharmaceutical interventions for each specialty are needed to change this situation.

Cited by 19 publications

References 29 publications

Hospital readmissions, mortality and potentially inappropriate prescribing: a retrospective study of older adults discharged from hospital

Hospital readmissions, mortality and potentially inappropriate prescribing: a retrospective study of older adults discharged from hospital

Assessment of inappropriate medication use in Jordanian elderly hospitalized patients using 2015 Beers criteria

Off‐label quetiapine prescribing in general hospital inpatients: an Australian experience

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