Antonio San-José1, Antonia Agustí2, Xavier Vidal2, Francesc Formiga3, Alfonso López-Soto4, Antonio Fernández-Moyano5, Juana García6, Nieves Ramírez-Duque7, Olga H Torres8, José Barbé9. 1. Internal Medicine Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Spain. Electronic address: asanjose@vhebron.net. 2. Clinical Pharmacology Service, Hospital Universitari Vall D'Hebron,Spain; Fundació Institut Català de Farmacologia, Spain; Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Spain. 3. Internal Medicine Service, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Spain. 4. Internal Medicine Service, Hospital Clínic, Barcelona, Spain; Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Spain. 5. Internal Medicine Service, Hospital San Juan De Dios del Aljarafe, Sevilla, Spain; Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Spain. 6. Internal Medicine Service, Hospital General Juan Ramón Jiménez, Huelva, Spain; Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Spain. 7. Internal Medicine Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Spain. 8. Universitat Autònoma de Barcelona, Barcelona, Spain; Internal Medicine Service, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Spain. 9. Internal Medicine Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Spain.
Abstract
PURPOSE: This study aims to assess inappropriate prescribing (IP) to elderly patients during the month prior to hospitalization and to compare different IP criteria. METHODS: An observational, prospective and multicentric study was carried out in the internal medicine services of seven Spanish hospitals. Patients aged 75years and older were randomly selected after hospital admission for a year. To assess potentially inappropriate medicines (PIMs), the Beers and STOPP criteria were used and to assess potentially prescribing omissions (PPOs), the START criteria and ACOVE-3 medicine quality indicators were used. An analysis to assess factors associated with IP was performed. RESULTS: 672 patients [median age (Q1-Q3) 82 (79-86) years, 55.9% female] were included. Median prescribed medicines in the month prior to hospitalization were 10(Q1-Q3 7-13). The prevalence of IP was 87.6%, and 54.3% of patients had PIMs and PPOs concurrently. A higher prevalence rate of PIMs was predicted using the STOPP criteria than with the Beers criteria (p<0.001) and a higher prevalence of PPOs using the ACOVE-3 criteria than using the START criteria (p<0.001) was observed. Polypharmacy (≥ 10 medicines) was the strongest predictor of IP [OR=11.34 95% confidence interval (CI) 4.96-25.94], PIMs [OR=14.16, 95% CI 6.44-31.12], Beers-listed PIMs [OR=8.19, 95% CI 3.01-22.28] and STOPP-listed PIMs [OR=8.21, 95% CI 3.47-19.44]. PIMs was the strongest predictor of PPOs [OR=2.79, 95% CI 1.81-4.28]. CONCLUSIONS: A high prevalence of polypharmacy and PIMs and PPOs were reported. More than half the patients had simultaneous PIMs and PPOs. The related factors to PIMs and PPOs were different.
PURPOSE: This study aims to assess inappropriate prescribing (IP) to elderly patients during the month prior to hospitalization and to compare different IP criteria. METHODS: An observational, prospective and multicentric study was carried out in the internal medicine services of seven Spanish hospitals. Patients aged 75years and older were randomly selected after hospital admission for a year. To assess potentially inappropriate medicines (PIMs), the Beers and STOPP criteria were used and to assess potentially prescribing omissions (PPOs), the START criteria and ACOVE-3 medicine quality indicators were used. An analysis to assess factors associated with IP was performed. RESULTS: 672 patients [median age (Q1-Q3) 82 (79-86) years, 55.9% female] were included. Median prescribed medicines in the month prior to hospitalization were 10(Q1-Q3 7-13). The prevalence of IP was 87.6%, and 54.3% of patients had PIMs and PPOs concurrently. A higher prevalence rate of PIMs was predicted using the STOPP criteria than with the Beers criteria (p<0.001) and a higher prevalence of PPOs using the ACOVE-3 criteria than using the START criteria (p<0.001) was observed. Polypharmacy (≥ 10 medicines) was the strongest predictor of IP [OR=11.34 95% confidence interval (CI) 4.96-25.94], PIMs [OR=14.16, 95% CI 6.44-31.12], Beers-listed PIMs [OR=8.19, 95% CI 3.01-22.28] and STOPP-listed PIMs [OR=8.21, 95% CI 3.47-19.44]. PIMs was the strongest predictor of PPOs [OR=2.79, 95% CI 1.81-4.28]. CONCLUSIONS: A high prevalence of polypharmacy and PIMs and PPOs were reported. More than half the patients had simultaneous PIMs and PPOs. The related factors to PIMs and PPOs were different.
Authors: Xavier Vidal; Antonia Agustí; Antoni Vallano; Francesc Formiga; Antonio Fernández Moyano; Juana García; Alfonso López-Soto; Nieves Ramírez-Duque; Olga H Torres; José Barbé; Antonio San-José Journal: Eur J Clin Pharmacol Date: 2016-03-05 Impact factor: 2.953
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