Inappropriate prescribing to older patients admitted to hospital: A comparison of different tools of misprescribing and underprescribing

Abstract

Methods: An observational, prospective and multicentric study was carried out in the internal medicine services of seven Spanish hospitals. Patients aged 75 years and older were randomly selected after hospital admission for a year. To assess potentially inappropriate medicines (PIMs), the Beers and STOPP criteria were used and to assess Potentially Prescribing Omissions (PPOs), the START criteria and ACOVE-3 medicine quality indicators were used. An analysis to assess factors associated with IP was performed.Results: 672 patients [median age (Q1_Q3) 82 (79-86) years, 55.9% female] were included. Median prescribed medicines in the month prior to hospitalization were 10(Q1-Q3 7-13). The prevalence of IP was 87.6%, and 54.3% of patients had PIMs and PPOs concurrently. A higher prevalence rate of PIMs was predicted using the STOPP criteria than with the Beers criteria (p<.001) and a higher prevalence of PPOs using the ACOVE-3 criteria than using the START criteria (p<.001) was observed. Polypharmacy (≥10 medicines) was the strongest Conclusions: A high prevalence of polypharmacy and PIMs and PPOs were reported. More than half the patients had simultaneous PIMs and PPOs. The related factors to PIMs and PPOs were different.

Potentially Inappropriate Antihypertensive Prescriptions to Elderly Patients: Results of a Prospective, Observational Study

“…Described below is a sub-study of the Potentially Inappropriate Prescribing in Older Patients in Spain (PIPOPS) study [15] that uses the previously described methodology [15,23]. The PIPOPS research project was a multicentre prospective observational study that tracked 672 patients aged 75 years and older, hospitalized for an acute event or exacerbation of a chronic condition in the internal medicine departments of seven Spanish hospitals between April 2011 and March 2012 (52 weeks).…”

“…Underprescribing is omission or underdosage of (or non-adherence to) a drug with a favourable benefit/risk ratio for the treatment or prevention of a condition or disease. Inappropriate prescription rates of between 25 and 75% in the elderly have been reported in the literature [15]. The application of criteria aimed at reducing potentially inappropriate prescriptions has been shown to reduce falls, delirium episodes, hospital stays, care visits (primary and emergency) and medication costs, although no evidence has been reported regarding quality-of-life or mortality improvements [18].…”

“…or the appropriateness of prescribed antihypertensive drugs. Geriatric syndromes in these often vulnerable and polymedicated patients frequently develop in the context of an adverse reaction to drugs, associated in turn with an increased risk of hospital admission and functional decline [15].…”

“…Criteria [11][12][13][14][15][16] have been devised to assist in identifying inappropriate prescriptions in the elderly. Inappropriate prescription, defined as a situation in which pharmacotherapy does not follow accepted medical standards, includes overprescribing, misprescribing and underprescribing [13].…”

Polypharmacy in elderly people with diabetes admitted to hospital

“…We carried out an observational, prospective, multicentric study on a cohort of 672 patients aged 75 and older patients hospitalized in the Internal Medicine Services of seven Spanish hospitals to evaluate the prevalence of Inappropriate prescribing [4]. Information on the number and type of prescription medicines during the month before admission was obtained using a complete pharmacological anamnesis as well as primary care electronic medical records review.…”