Selection of tools for reconciliation, compliance and appropriateness of treatment in patients with multiple chronic conditions

Alfaro-Lara, Eva Rocío; Coca, M Dolores Vega; Galván-Banqueri, Mercedes; Gil, R. Marín; Nieto-Martín, María Dolores; Pérez‐Guerrero, Concepción; Baturone, Manuel Ollero; Santos-Ramos, Bernardo

doi:10.1016/j.ejim.2012.06.007

Cited by 23 publications

(12 citation statements)

References 37 publications

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“… 8.5 There are no effective non-pharmacological alternatives available Clinical response Is the drug effective for this indication? Lara, 2012 [ 26 ] - Literature based - Expert panel - Developed from literature review and a two-stage consensus process with panel of 11 multidisciplinary experts 8.5 The drug is effective in this patient for this indication Interaction Are there clinically significant drug–drug interactions? Hanlon, 1992 [ 14 ] - Literature based - Expert review - Developed from literature review; clinical pharmacist and internist-geriatrician identified key elements to derive criteria 9 There are no clinically significant drug–drug interactions (including duplication of therapy) Complexity of medication Could the drug regimen be simplified?…”

Section: Resultsmentioning

confidence: 99%

Developing a measure of polypharmacy appropriateness in primary care: systematic review and expert consensus study

Burt

Elmore

Campbell

et al. 2018

BMC Med

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BackgroundPolypharmacy is an increasing challenge for primary care. Although sometimes clinically justified, polypharmacy can be inappropriate, leading to undesirable outcomes. Optimising care for polypharmacy necessitates effective targeting and monitoring of interventions. This requires a valid, reliable measure of polypharmacy, relevant for all patients, that considers clinical appropriateness and generic prescribing issues applicable across all medications. Whilst there are several existing measures of potentially inappropriate prescribing, these are not specifically designed with polypharmacy in mind, can require extensive clinical input to complete, and often cover a limited number of drugs. The aim of this study was to identify what experts consider to be the key elements of a measure of prescribing appropriateness in the context of polypharmacy.MethodsFirstly, we conducted a systematic review to identify generic (not drug specific) prescribing indicators relevant to polypharmacy appropriateness. Indicators were subject to content analysis to enable categorisation. Secondly, we convened a panel of 10 clinical experts to review the identified indicators and assess their relative clinical importance. For each indicator category, a brief evidence summary was developed, based on relevant clinical and indicator literature, clinical guidance, and opinions obtained from a separate patient discussion panel. A two-stage RAND/UCLA Appropriateness Method was used to reach consensus amongst the panel on a core set of indicators of polypharmacy appropriateness.ResultsWe identified 20,879 papers for title/abstract screening, obtaining 273 full papers. We extracted 189 generic indicators, and presented 160 to the panel grouped into 18 classifications (e.g. adherence, dosage, clinical efficacy). After two stages, during which the panel introduced 18 additional indicators, there was consensus that 134 indicators were of clinical importance. Following the application of decision rules and further panel consultation, 12 indicators were placed into the final selection. Panel members particularly valued indicators concerned with adverse drug reactions, contraindications, drug-drug interactions, and the conduct of medication reviews.ConclusionsWe have identified a set of 12 indicators of clinical importance considered relevant to polypharmacy appropriateness. Use of these indicators in clinical practice and informatics systems is dependent on their operationalisation and their utility (e.g. risk stratification, targeting and monitoring polypharmacy interventions) requires subsequent evaluation.Trial registrationRegistration number: PROSPERO (CRD42016049176).Electronic supplementary materialThe online version of this article (10.1186/s12916-018-1078-7) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Developing a measure of polypharmacy appropriateness in primary care: systematic review and expert consensus study

Burt

Elmore

Campbell

et al. 2018

BMC Med

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“…In 2010, Levy and colleagues indicated that the STOPP/START criteria may be a good choice as an universal explicit criteria . In 2012, a group of researchers and clinicians chose the STOPP/START criteria as the ‘most appropriate’ choice for evaluating the prescribing of patients with multiple chronic conditions in Spain . These tools have been proposed as the most appropriate for assessing PIP in the Netherlands .…”

Section: What Is Known and Objectivementioning

confidence: 99%

Application of the STOPP/START criteria: a systematic review of the prevalence of potentially inappropriate prescribing in older adults, and evidence of clinical, humanistic and economic impact

et al. 2013

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of older person's potentially inappropriate prescriptions, screening tool to alert doctors to the right treatment SUMMARYWhat is known and Objective: Potentially inappropriate prescribing (PIP) has significant clinical, humanistic and economic impacts. Identifying PIP in older adults may reduce their burden of adverse drug events. Tools with explicit criteria are being developed to screen for PIP in this population. These tools vary in their ability to identify PIP in specific care settings and jurisdictions due to such factors as local prescribing practices and formularies. One promising set of screening tools are the STOPP (Screening Tool of Older Person's potentially inappropriate Prescriptions) and START (Screening Tool of Alert doctors to the Right Treatment) criteria. We conducted a systematic review of research studies that describe the application of the STOPP/START criteria and examined the evidence of the impact of STOPP/START on clinical, humanistic and economic outcomes in older adults. Methods: We performed a systematic review of studies from relevant biomedical databases and grey literature sources published from January 2007 to January 2012. We searched citation and reference lists and contacted content experts to identify additional studies. Two authors independently selected studies using a predefined protocol. We did not restrict selection to particular study designs; however, non-English studies were excluded during the selection process. Independent extraction of articles by two authors used predefined data fields. For randomized controlled trials and observational studies comparing STOPP/START to other explicit criteria, we assessed risk of bias using an adapted tool. Results and Discussion: We included 13 studies: a single randomized controlled trial and 12 observational studies. We performed a descriptive analysis as heterogeneity of study populations, interventions and study design precluded metaanalysis. All observational studies reported the prevalence of PIP; however, the application of the criteria was not consistent across all studies. Seven of the observational studies compared STOPP/ START with other explicit criteria. The STOPP/START criteria were reported to be more sensitive than the more-frequentlycited Beers criteria in six studies, but less sensitive than a set of criteria developed in Australia. The STOPP criteria identified more medications associated with adverse drug events than the 2002 version of the Beers criteria. Patients with PIP, as identified by STOPP, had an 85% increased risk of adverse drug events in one study (OR = 1Á85, 95% CI: 1Á51-2Á26; P < 0Á001). There was limited evidence that the application of STOPP/START criteria optimized prescribing. Research involving the application of STOPP/START on the impact on the quality of life was not found. The direct costs of PIP were documented in three studies from Ireland, but more extensive analyses on the economic impact or studies from other jurisdictions were not found. What is new and Conclusion: The STOPP/START c...

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“…Explicit prescribing criteria have been developed to raise prescribers’ and other healthcare providers’ awareness about inappropriate prescribing and to improve the quality of prescribing in the elderly [ 12 , 13 ]. The Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP), published in 2008 [ 14 ], has been endorsed by researchers in different jurisdictions, in Europe and elsewhere, for evaluating the quality of prescribing of elderly patients with multiple chronic conditions [ 15 – 18 ]. However, evidence of an association between PIPs identified by STOPP criteria and the occurrence of ADRs is limited [ 19 ] and mainly studied in hospital settings [ 20 – 22 ].…”

Section: Introductionmentioning

confidence: 99%

Potentially inappropriate prescribing and adverse drug reactions in the elderly: a population-based study

Hedna

Hakkarainen

Gyllensten

et al. 2015

Eur J Clin Pharmacol

118

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PurposePotentially inappropriate prescriptions (PIPs) criteria are widely used for evaluating the quality of prescribing in elderly. However, there is limited evidence on their association with adverse drug reactions (ADRs) across healthcare settings. The study aimed to determine the prevalence of PIPs, defined by the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) criteria, in the Swedish elderly general population and to investigate the association between PIPs and occurrence of ADRs.MethodPersons ≥65 years old were identified from a random sample of 5025 adults drawn from the Swedish Total Population Register. A retrospective cohort study was conducted among 813 elderly with healthcare encounters in primary and specialised healthcare settings during a 3-month period in 2008. PIPs were identified from the Swedish Prescribed Drug Register, medical records and health administrative data. ADRs were independently identified by expert reviewers in a stepwise manner using the Howard criteria. Multivariable logistic regression examined the association between PIPs and ADRs.ResultsOverall, 374 (46.0 %) persons had ≥1 PIPs and 159 (19.5 %) experienced ≥1 ADRs during the study period. In total, 29.8 % of all ADRs was considered caused by PIPs. Persons prescribed with PIPs had more than twofold increased odds of experiencing ADRs (OR 2.47; 95 % CI 1.65–3.69). PIPs were considered the cause of 60 % of ADRs affecting the vascular system, 50 % of ADRs affecting the nervous system and 62.5 % of ADRs resulting in falls.ConclusionPIPs are common among the Swedish elderly and are associated with increased odds of experiencing ADRs. Thus, interventions to decrease PIPs may contribute to preventing ADRs, in particular ADRs associated with nervous and vascular disorders and falls.Electronic supplementary materialThe online version of this article (doi:10.1007/s00228-015-1950-8) contains supplementary material, which is available to authorized users.

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Selection of tools for reconciliation, compliance and appropriateness of treatment in patients with multiple chronic conditions

Cited by 23 publications

References 37 publications

Developing a measure of polypharmacy appropriateness in primary care: systematic review and expert consensus study

Developing a measure of polypharmacy appropriateness in primary care: systematic review and expert consensus study

Application of the STOPP/START criteria: a systematic review of the prevalence of potentially inappropriate prescribing in older adults, and evidence of clinical, humanistic and economic impact

Potentially inappropriate prescribing and adverse drug reactions in the elderly: a population-based study

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