Prevalence of potentially inappropriate prescribing in a subpopulation of older European clinical trial participants: a cross-sectional study

Abstract

ObjectivesTo estimate and compare the prevalence and type of potentially inappropriate prescribing (PIP) and potential prescribing omissions (PPOs) among community-dwelling older adults (≥65 years) enrolled to a clinical trial in three European countries.DesignA secondary analysis of the Thyroid Hormone Replacement for Subclinical Hypothyroidism Trial dataset.ParticipantsA subset of 48/80 PIP and 22/34 PPOs indicators from the Screening Tool of Older Persons Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) V2 criteria were applied to prescribed medication data for 532/737 trial participants in Ireland, Switzerland and the Netherlands.ResultsThe overall prevalence of PIP was lower in the Irish participants (8.7%) compared with the Swiss (16.7%) and Dutch (12.5%) participants (P=0.15) and was not statistically significant. The overall prevalence of PPOs was approximately one-quarter in the Swiss (25.3%) and Dutch (24%) participants and lower in the Irish (14%) participants (P=0.04) and the difference was statistically significant. The hypnotic Z-drugs were the most frequent PIP in Irish participants, (3.5%, n=4), while it was non-steroidal anti-inflammatory drug and oral anticoagulant combination, sulfonylureas with a long duration of action, and benzodiazepines (all 4.3%, n=7) in Swiss, and benzodiazepines (7.1%, n=18) in Dutch participants. The most frequent PPOs in Irish participants were vitamin D and calcium in osteoporosis (3.5%, n=4). In the Swiss and Dutch participants, they were bone antiresorptive/anabolic therapy in osteoporosis (9.9%, n=16, 8.6%, n=22) respectively. The odds of any PIP after adjusting for age, sex, multimorbidity and polypharmacy were (adjusted OR (aOR)) 3.04 (95% CI 1.33 to 6.95, P<0.01) for Swiss participants and aOR 1.74 (95% CI 0.79 to 3.85, P=0.17) for Dutch participants compared with Irish participants. The odds of any PPOs were aOR 2.48 (95% CI 1.27 to 4.85, P<0.01) for Swiss participants and aOR 2.10 (95% CI 1.11 to 3.96, P=0.02) for Dutch participants compared with Irish participants.ConclusionsThis study has estimated and compared the prevalence and type of PIP and PPOs among this cohort of community-dwelling older people. It demonstrated a significant difference in the prevalence of PPOs between the three populations. Further research is urgently needed into the impact of system level factors as this has important implications for patient safety, healthcare provision and economic costs.

Prevalence and predictors of inappropriate prescribing according to the Screening Tool of Older People's Prescriptions and Screening Tool to Alert to Right Treatment version 2 criteria in older patients discharged from geriatric and internal medicine wards: A prospective observational multicenter study

“…25 Lower prevalences of PIM and PPO (12.9% and 22.2%, respectively) were observed in 532 community-dwelling patients (mean age 75 years) from three European countries. 15 In keeping with previous studies, benzodiazepines and PPI were the most frequent PIM in our sample. 8 STOPP/STARTv2 in hospital-discharged patients our sample, PPI inappropriateness was more often related to the lack of an evidence-based indication (STOPP A1), rather than to an inappropriate duration of appropriate therapy (STOPP F2).…”

“…In a sample of 319 patients (mean age 69 years) discharged from the cardiology and internal medicine departments of an Albanian hospital, 63.0% of patients presented at least one PIM, a figure similar to what we detected among internal medicine‐discharged patients (63.8%) . Lower prevalences of PIM and PPO (12.9% and 22.2%, respectively) were observed in 532 community‐dwelling patients (mean age 75 years) from three European countries …”

“…STOPP C1 "long-term aspirin at doses >160 mg/day" does not define "long term"), thus requiring a subjective judgment. 15 In conclusion, the present findings highlight that IP is highly prevalent among older hospital-discharged patients. Polypharmacy is associated with IP, considered both as PIM and as PPO, whereas geriatric discharge seems to be protective.…”

“…Finally, as underlined by other authors, some criteria are not completely explicit (e.g. STOPP C1 “long‐term aspirin at doses >160 mg/day” does not define “long term”), thus requiring a subjective judgment …”

“…12,13 Few studies have investigated the prevalence of PIM and PPO according to STOPP/START v2, mainly retrospectively on community-dwellers. [14][15][16] The present two-phase prospective observational study aimed to evaluate the prevalence, predictors and potential clinical implications (death and readmissions) of IP according to STOPP/START v2 among hospital-discharged older patients. In this study, we report the results of the cross-sectional part of the study.…”