Screening Tool of Older Person's Prescriptions/Screening Tools to Alert Doctors to Right Treatment Medication Criteria Modified for U.S. Nursing Home Setting

Abstract

STRUCTURED ABSTRACT BACKGROUND/OBJECTIVES A barrier to assessing the quality of prescribing in nursing homes (NH) is the lack of explicit criteria for this setting. Our objective was to develop a set of prescribing indicators measurable with available data from electronic nursing home databases by adapting the European-based 2014 STOPP/START criteria of potentially inappropriate and underused medications for the US setting. DESIGN A two-stage expert panel process. In first stage, investigator team reviewed 114 criteria for compatibility and measurability. In second stage, we convened an online modified e-Delphi (OMD) panel to rate the validity of criteria and two webinars to identify criteria with highest relevance to US NHs. PARTICIPANTS Seventeen experts with recognized reputations in NH care participated in the e-Delphi panel and 12 in the webinar. MEASUREMENTS Compatibility and measurability were assessed by comparing criteria to US terminology/setting standards and data elements in NH databases. Validity was rated with a 9-point Likert-type scale (1=not valid at all, 9=highly valid). Mean, median, interpercentile ranges, and agreement were determined for each criterion score. Relevance was determined by ranking the mean panel ratings on criteria that reached agreement; half of the criteria with the highest mean values were reviewed and approved by the webinar participants. RESULTS Fifty-three STOPP/START criteria were deemed as compatible with US setting and measurable using data from electronic NH databases. E-Delphi panelists rated 48 criteria as valid for US NHs. Twenty-four criteria were deemed as most relevant, consisting of 22 measures of potentially inappropriate medications and 2 measures of underused medications. CONCLUSION This study created the first explicit criteria for assessing the quality of prescribing in US NHs.

Potentially Inappropriate Prescribing in Belgian Nursing Homes: Prevalence and Associated Factors

“…The recently developed explicit PIP criteria for NHs in the United States has 24 criteria, of which only 2 are measures of underused medications. 44 The present study has some limitations. First, the STOPP/START and Beers criteria were developed for older people but are not specifically tailored to the situation of NHRs.…”

Identifying potential prescribing safety indicators related to mental health disorders and medications: A systematic review

“…Most studies developed prescribing indicator tools to be used in the United States of America (USA) [32, 34, 39, 69, 79–81, 88, 89, 102, 105, 106, 109, 111, 113, 117, 118] (n = 17/70, 24.3%), followed by the United Kingdom (UK) [10, 11, 15, 17, 22, 61, 62, 73] (n = 8, 11.4%) and Canada [41, 72, 86, 93, 107, 112] (n = 6, 8.6%). The remaining studies described tools developed for Ireland [68, 78, 99, 115] (n = 4, 5.7%), Spain [43, 75, 77] (n = 3, 4.3%), Australia [64, 65, 74] (n = 3, 4.3%), Norway [95, 96, 108] (n = 3, 4.3%), Belgium [42, 48, 104] (n = 3, 4.3%), The Netherlands [92, 114] (n = 2, 2.9%), Italy [31, 44] (n = 2, 2.9%), France [87, 103] (n = 2, 2.9%), Korea [83, 84] (n = 2, 2.9%), Germany [45] (n = 1, 1.4%), Taiwan [66] (n = 1, 1.4%), Austria [90] (n = 1, 1.4%), the Czech Republic [47] (n = 1, 1.4%), Portugal [50] (n = 1, 1.4%), Japan [85] (n = 1, 1.4%), Argentina […”

“…The elderly population was the most common patient group specifically targeted by the indicator tools (n = 38/70, 54.3%). Of these, 26/38 (68.4%) [25, 31, 32, 34, 41, 43–47, 61, 64, 66, 74, 77, 83, 84, 88, 90, 92, 101, 106–108, 112, 118] studies defined their elderly population as ≥65 years old, 3 (7.9%) [68, 95, 96] as ≥70 years old, 2 (5.3%) [85, 87] as ≥75 years old, and the remaining 7 (18.4%) [38, 42, 48, 91, 93, 114, 116] tools did not define a specific age. Of the remaining studies, 5/70 (7.1%) [39, 71, 81, 111, 113] described tools specifically for adults, 2 (2.9%) [79, 103] for paediatric patients, 4 (5.7%) for psychiatric patients (including bipolar disorder (n = 1),[49] general psychiatric patients (n = 1)[22] and severe/advanced dementia (n = 2)[80, 86]), and 1 (1.4%) [72] for patients with chronic kidney disease.…”

“…Seventeen (24.3%) studies did not specify a setting for their developed tools. The remaining tools targeted hospitals (n = 9/70, 12.9%) [15, 22, 65, 71, 74, 77, 79, 104, 117], multiple settings (n = 9, 12.9%) [25, 34, 49, 64, 66, 78, 84, 90, 112], long-term care settings (n = 8, 11.8%) [32, 41, 61, 80, 86, 95, 108, 114] and pharmacies (n = 5, 7.1%) [48, 72, 89, 102, 109].…”

“…A medication that can be used to treat or prevent any mental health condition (e.g. prescribing atypical antipsychotic for elderly [31, 32] ), unless the indicator was specific for a non-mental health indication (e.g. clonidine for the treatment of arterial hypertension in the elderly [33] ),…”