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

Abstract

Purpose: The increase in drug prescription for the elderly raises the risk of the occurrence of potentially inappropriate medications (PIMs), thus increasing the incidence of drug-related problems. Likewise, potential prescribing omissions (PPOs) are also highly prevalent in the elderly. This study aimed at assessing the prevalence of PIMs in the elderly by using the EU (7)-PIM list, STOPP criteria version 2 and the Beers criteria version 2015, as well as the prevalence of PPOs by applying the START criteria version 2 in elderly nursing home residents and outpatients of the Eastern Central Region of Portugal. Patients and Methods: A descriptive cross-sectional study was carried out in a sample of 90 Portuguese elderly people. Age, gender, diagnoses and medication history were collected from the patients' clinical records. The prevalence of PIMs and PPOs was measured according to each of the criteria applied. Results: The patients' ages ranged from 65 to 103 years, with an average age of 84.15 years. In addition, the average number of medications prescribed was 7.6. The STOPP criteria identified 250 PIMs affecting 77 patients (85.5%), the EU(7)-PIM list detected 94 PIMs in 58 patients (64.4%) and the Beers criteria identified 69 PIMs in 51 patients (56.6%). Therefore, the STOPP criteria version 2 identified substantially more PIMs than the other two tools. Furthermore, by applying the START criteria 68 PPOs were detected in 52 patients (57.7%). Conclusion: A high prevalence of PIMs and PPOs was observed, suggesting the need to implement actions aimed at reducing the phenomenon and thus help to improve the quality of care provided in nursing homes. The variations in prevalence with the different tools suggest the need to carefully choose the tool for medication review in the elderly.

Factors associated to potentially inappropriate prescribing in older patients according to STOPP/START criteria: MoPIM multicentre cohort study

“…An important finding of this study is that the most frequent active principles as PIMs, which were PPIs and BZDs, were present in almost half (46.6%) of the patients, suggesting that actions focused on deprescribing these medications may have a large impact on reducing PIP and, therefore, undesired negative outcomes. Remarkably, many other studies have previously found either BZDs alone [ 28 – 30 ] or together with PPIs [ 4 , 12 , 31 – 33 ] among the most frequent PIMs.…”

Prescription of Potentially Inappropriate Medication in Older Inpatients of an Internal Medicine Ward: Concordance and Overlap Among the EU(7)-PIM List and Beers and STOPP Criteria

“…The number of PIMs identified varies among criteria, and in the inpatient setting, the prevalence of PIM changes from 1% to as high as 50% and is highly dependent on the tool used to define PIM (Franceschi et al, 2008;Rothberg et al, 2008;Page et al, 2010). A study carried out in Portuguese nursing homes and day-care centers detected a PIM prevalence of 64.4% when applying the EU( 7)-PIM list, 56% when applying the 2015 Beers criteria, and 85.5% when applying the STOPP v2 criteria (Monteiro et al, 2020). Another study carried out in Chinese inpatients reported a prevalence of PIM of 58.1 and 44.0% using 2015 Beers criteria and 2014 STOPP (Ma et al, 2019).…”

What influences prescribing decisions in a multimorbidity and polypharmacy context on the acute medical unit? An interprofessional, qualitative study

“…Prescribing tools such as Beers and STOPP/START criteria have been available for over a decade and have been integrated into computerized clinical decision support systems (CDSS). Prescribing tools have been successfully deployed to quantify the incidence of inappropriate prescribing but several studies over recent years, in a variety of clinical settings, have demonstrated that there is insufficient evidence of their clinical or economic impact 14,29‐33 . The failure of prescribing tools such as STOPP/START to reduce the incidence of inappropriate prescribing suggests that an alternative approach may be worthy of consideration.…”

“…Prescribing tools have been successfully deployed to quantify the incidence of inappropriate prescribing but several studies over recent years, in a variety of clinical settings, have demonstrated that there is insufficient evidence of their clinical or economic impact. 14,[29][30][31][32][33] The failure of prescribing tools such as STOPP/START to reduce the incidence of inappropriate prescribing suggests that an alternative approach may be worthy of consideration. Hence, we propose that a greater understanding of factors that directly influence doctors during routine practice at the point of prescribing may help point the way towards providing better support for prescribers, including CDSS support, to ensure prescribing guidance translates into patient benefit.…”