Pharmaceutical Intervention to Manage Polypharmacy in Elderly Patients based on STOPP Criteria

Abstract

Polypharmacy, the co-prescribing of nonessential drugs and inappropriate prescriptions, is a worldwide issue and is a factor affecting the increase in adverse drug reactions, drug-drug and drug-disease state interactions, and the growth in medical spending. In this study, we evaluated the current status of polypharmacy in elderly patients at Kobe University Hospital and the efficacy for screening and intervention against potentially inappropriate medications (PIMs) with the screening tool of older persons＇ potentially inappropriate prescriptions (STOPP) criteria formulated by a pharmacist. Of 301 study patients, 81 (26.9％) patients with PIMs were identified using the STOPP criteria, and these patients had a significantly higher number of prescribed drugs than other patients. Moreover, there was a correlation between the number of prescribed drugs and the percentage of patients identified using the STOPP criteria. The STOPP criteria identified 125 cases to be PIMs, and the prescriptions were changed for 35 (28％) of them. In 125 cases of PIMs, 61 cases had been strongly recommended prescription changes by pharmacists, of which 32 cases (52.5％) had been changed. Several prescription changes were often associated with the administration of nonsteroidal anti-inflammatory drugs. Based on our findings, we suggest that the STOPP criteria are useful for screening PIMs in Japanese patients and are a helpful tool for managing polypharmacy. The benefits of this approach for pharmacists should be multilaterally evaluated by the assessment of patients and medical economic outcomes in the future.

Multidrug use positively correlates with high-risk prescriptions in the Japanese elderly: a longitudinal study

“…In Japan, the “Screening Tool for Older Persons’ Appropriate Prescriptions for Japanese (STOPP-J) [8]” is used. The use of drugs related to the Beers or STOPP criteria and the consequent under-prescribing of medications were reported to be frequent in patients receiving multidrug treatment [9–11]; similar reports were also published in Japan [12, 13]. We hypothesize that adverse events tend to occur in patients receiving multidrug treatment because of high-risk prescriptions.…”

Places to Managing Medicines Patients Brought in Hospital: Which is Better Central Pharmacy or Hospital Wards?

“…For example, Imai et al, reported that the service prevents potential adverse drug reactions [9] and Horiuchi et al, reported that screening of cancellation medicine before operation at medicine support center [13]. The CPBM is necessary to evaluate patients' pharmacotherapy and pharmacists could work for the risk management using STOPP criteria [14][15][16]. In the NCCHE, pharmacists do not use STOPP criteria [14] for inpatient intervention, however, the change of work setting was associated with a twofold increase in pharmacy interventions for patients' treatment.…”