Potentially inappropriate prescribing in older hospitalized Dutch patients according to the STOPP/START criteria v2: a longitudinal study

Damoiseaux-Volman, Birgit A.; Medlock, Stephanie; Raven, Kimmy; Sent, Danielle; Romijn, Johannes A.; Velde, Nathalie van der; Abu‐Hanna, Ameen

doi:10.1007/s00228-020-03052-2

Cited by 15 publications

(13 citation statements)

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“…Consistent with other studies, the multivariate logistic regression identified several age-specific factors associated with multimorbidity, polypharmacy, and PIM use [ 38 , 39 , 40 , 41 , 42 , 43 ]. As a rule of thumb, many body functions decline in old age, which is a frequent cause of multimorbidity [ 1 , 10 , 14 , 44 , 45 ].…”

Section: Discussionsupporting

confidence: 86%

Prevalence and Determinants of Multimorbidity, Polypharmacy, and Potentially Inappropriate Medication Use in the Older Outpatients: Findings from EuroAgeism H2020 ESR7 Project in Ethiopia

et al. 2021

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Few studies have been conducted on multimorbidity (two or more chronic diseases) and rational geriatric prescribing in Africa. This study examined the prevalence and determinants of multimorbidity, polypharmacy (five or more long-term medications), and potentially inappropriate medication (PIM) use according to the 2019 Beers criteria among the older adults attending chronic care clinics from a single institution in Ethiopia. A hospital-based cross-sectional study was conducted among 320 randomly selected older adults from 12 March 2020 to 30 August 2020. A multivariable logistic regression analysis was performed to identify the predictor variables. The prevalence of multimorbidity, polypharmacy, and PIM exposure was 59.1%, 24.1%, and 47.2%, respectively. Diuretics (10%), insulin sliding scale (8.8%), amitriptyline (7.8%), and aspirin (6.9%) were among the most frequently prescribed PIMs. Older patients experiencing pain flare-ups were more likely to have multimorbidity (adjusted odds ratio (AOR): 1.64, 95% confidence intervals: 1.13–2.39). Persistent anger (AOR: 3.33; 1.71–6.47) and use of mobility aids (AOR: 2.41, 1.35–4.28) were associated with polypharmacy. Moreover, cognitive impairment (AOR: 1.65, 1.15–2.34) and health deterioration (AOR: 1.61, 1.11–2.32) increased the likelihood of PIM exposure. High prevalence of multimorbidity and PIM use was observed in Ethiopia. Several important determinants that can be modified by applying PIM criteria in routine practice were also identified.

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Section: Discussionsupporting

confidence: 86%

Prevalence and Determinants of Multimorbidity, Polypharmacy, and Potentially Inappropriate Medication Use in the Older Outpatients: Findings from EuroAgeism H2020 ESR7 Project in Ethiopia

et al. 2021

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“…STOPP section K included ‘benzodiazepines with history or risk of falls’ (22.1%), ‘neuroleptic drugs with history or risk of falls’ (10.2%), ‘hypnotic Z-drugs with history or risk of falling’ (2.8%) and ‘vasodilator drugs with orthostatic hypotension’ (0.1%). Detailed prevalences of all STOPP/START v2 can be found in our previous paper [ 16 ]. Three of the five most common STOPPFalls administered in our population belonged to the STOPPFall group opioids.…”

Section: Resultsmentioning

confidence: 99%

“…The technical translation of the Dutch STOPP criteria v2 has been described previously and was based on the consensus study of Huibers et al . [ 16 , 17 ]. In total, 68 STOPP criteria were included, coded by B.A.-D.V.…”

Section: Methodsmentioning

confidence: 99%

Potentially inappropriate medications and their effect on falls during hospital admission

et al. 2021

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Objective to investigate the effect of potentially inappropriate medications (PIMs) on inpatient falls and to identify whether PIMs as defined by STOPPFall or the designated section K for falls of STOPP v2 have a stronger association with inpatient falls when compared to the general tool STOPP v2. Methods a retrospective observational matching study using an electronic health records dataset of patients (≥70 years) admitted to an academic hospital (2015–19), including free text to identify inpatient falls. PIMs were identified using the STOPP v2, section K of STOPP v2 and STOPPFall. We first matched admissions with PIMs to those without PIMs on confounding factors. We then applied multinomial logistic regression analysis and Cox proportional hazards analysis on the matched datasets to identify effects of PIMs on inpatient falls. Results the dataset included 16,678 hospital admissions, with a mean age of 77.2 years. Inpatient falls occurred during 446 (2.7%) admissions. Adjusted odds ratio (OR) (95% confidence interval (CI)) for the association between PIM exposure and falls were 7.9 (6.1–10.3) for STOPP section K, 2.2 (2.0–2.5) for STOPP and 1.4 (1.3–1.5) for STOPPFall. Adjusted hazard ratio (HR) (95% CI) for the effect on time to first fall were 2.8 (2.3–3.5) for STOPP section K, 1.5 (1.3–1.6) for STOPP and 1.3 (1.2–1.5) for STOPPFall. Conclusions we identified an independent association of PIMs on inpatient falls for all applied (de)prescribing tools. The strongest effect was identified for STOPP section K, which is restricted to high-risk medication for falls. Our results suggest that decreasing PIM exposure during hospital stay might benefit fall prevention, but intervention studies are warranted.

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“…prospective vs. retrospective). For instance, a recent study found a lower prevalence of potential overuse (56%) and potential underuse (58%) after application of STOPP/START v2 algorithms on a database with medical information from older hospitalised patients [ 19 ]. Retrospective database studies are often limited by incomplete documentation of relevant medical information, directly affecting the prevalence of STOPP/START signals.…”

Section: Discussionmentioning

confidence: 99%

“…Missing data: renal function, 74 (9.0%); nursing home residents, 3 (0.4%); Barthel Index of ADL, 11 (1.3%); housebound, 2 (0.2%); number of falls during the previous year, 9 (1.1%); number of hospitalisations in the previous year, 3 (0.4%); length of stay during index hospitalisation, 2 (0.2%); admission type, 5 (0.6%) ADL activities of daily living, CKD-EPI chronic kidney disease epidemiology collaboration equation a ADL as measured by the Barthel Index. Values range from 0 to 100, with higher values indicating higher functional independence [18] Characteristics hospitalised patients [19]. Retrospective database studies are often limited by incomplete documentation of relevant medical information, directly affecting the prevalence of STOPP/ START signals.…”

Section: Frequency and Acceptancementioning

confidence: 99%

Frequency and Acceptance of Clinical Decision Support System-Generated STOPP/START Signals for Hospitalised Older Patients with Polypharmacy and Multimorbidity

et al. 2021

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Background The Screening Tool of Older Persons' Prescriptions (STOPP)/Screening Tool to Alert to Right Treatment (START) instrument is used to evaluate the appropriateness of medication in older people. STOPP/START criteria have been converted into software algorithms and implemented in a clinical decision support system (CDSS) to facilitate their use in clinical practice. Objective Our objective was to determine the frequency of CDSS-generated STOPP/START signals and their subsequent acceptance by a pharmacotherapy team in a hospital setting. Design and Methods Hospitalised older patients with polypharmacy and multimorbidity allocated to the intervention arm of the OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly) trial underwent a CDSS-assisted structured medication review in four European hospitals. We evaluated the frequency of CDSS-generated STOPP/START signals and the subsequent acceptance of these signals by a trained pharmacotherapy team consisting of a physician and pharmacist after evaluation of clinical applicability to the individual patient, prior to discussing pharmacotherapy optimisation recommendations with the patient and attending physicians. Multivariate linear regression analysis was used to investigate potential patient-related (e.g. age, number of co-morbidities and medications) and setting-related (e.g. ward type, country of inclusion) determinants for acceptance of STOPP and START signals. ResultsIn 819/826 (99%) of the patients, at least one STOPP/START signal was generated using a set of 110 algorithms based on STOPP/START v2 criteria. Overall, 39% of the 5080 signals were accepted by the pharmacotherapy team. There was a high variability in the frequency and the subsequent acceptance of the individual STOPP/START criteria. The acceptance ranged from 2.5 to 75.8% for the top ten most frequently generated STOPP and START signals. The signal to stop a drug without a clinical indication was most frequently generated (28%), with more than half of the signals accepted (54%). No difference in mean acceptance of STOPP versus START signals was found. In multivariate analysis, most patient-related determinants did not predict acceptance, although the acceptance of START signals increased in patients with one or more hospital admissions (+ 7.9; 95% confidence interval [CI] 1.6-14.1) or one or more falls in the previous year (+ 7.1; 95% CI 0.7-13.4). A higher number of co-morbidities was associated with lower acceptance of STOPP (− 11.8%; 95% CI − 19.2 to − 4.5) and START (− 11.0%; 95% CI − 19.4 to − 2.6) signals for patients with more than nine and between seven and nine co-morbidities, respectively. For setting-related determinants, the acceptance differed significantly between the participating trial sites. Compared with Switzerland, the acceptance was higher in Ireland (STOPP: + 26.8%; 95% CI 16.8-36.7; START: + 31.1%; 95% CI 18.2-44.0) and in the Netherlands (STOPP: + 14.7%; 95% CI 7.8-21.7). Admission to a surgical ward was positively associated w...

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Potentially inappropriate prescribing in older hospitalized Dutch patients according to the STOPP/START criteria v2: a longitudinal study

Cited by 15 publications

References 32 publications

Prevalence and Determinants of Multimorbidity, Polypharmacy, and Potentially Inappropriate Medication Use in the Older Outpatients: Findings from EuroAgeism H2020 ESR7 Project in Ethiopia

Prevalence and Determinants of Multimorbidity, Polypharmacy, and Potentially Inappropriate Medication Use in the Older Outpatients: Findings from EuroAgeism H2020 ESR7 Project in Ethiopia

Potentially inappropriate medications and their effect on falls during hospital admission

Frequency and Acceptance of Clinical Decision Support System-Generated STOPP/START Signals for Hospitalised Older Patients with Polypharmacy and Multimorbidity

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