Inappropriate prescribing to older patients admitted to hospital: A comparison of different tools of misprescribing and underprescribing
Por:
San-Jose, A, Agusti, A, Vidal, X, Formiga, F, Lopez-Soto, A, Fernandez-Moyano, A, Garcia, J, Ramirez-Duque, N, Torres, OH, Barbe, J
Publicada:
1 oct 2014
Resumen:
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 75 years and olderwere 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. (c) 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
Filiaciones:
San-Jose, A:
Hosp Univ Vall Hebron, Internal Med Serv, Barcelona 08035, Spain
Univ Autonoma Barcelona, E-08193 Barcelona, Spain
Spanish Soc Internal Med, Multimorbid & Elderly Patients Grp, Murcia, Spain
Agusti, A:
Hosp Univ Vall Hebron, Clin Pharmacol Serv, Barcelona 08035, Spain
Fundacio Inst Catala Farmacol, Barcelona, Spain
Univ Autonoma Barcelona, Dept Pharmacol Therapeut & Toxicol, E-08193 Barcelona, Spain
Vidal, X:
Hosp Univ Vall Hebron, Clin Pharmacol Serv, Barcelona 08035, Spain
Fundacio Inst Catala Farmacol, Barcelona, Spain
Univ Autonoma Barcelona, Dept Pharmacol Therapeut & Toxicol, E-08193 Barcelona, Spain
Formiga, F:
Hosp Univ Bellvitge, Hosp Llobregat, Internal Med Serv, Barcelona, Spain
Spanish Soc Internal Med, Multimorbid & Elderly Patients Grp, Murcia, Spain
Lopez-Soto, A:
Hosp Clin Barcelona, Internal Med Serv, Barcelona, Spain
Spanish Soc Internal Med, Multimorbid & Elderly Patients Grp, Murcia, Spain
Fernandez-Moyano, A:
Hosp San Juan Dios Aljarafe, Internal Med Serv, Seville, Spain
Spanish Soc Internal Med, Multimorbid & Elderly Patients Grp, Murcia, Spain
Garcia, J:
Hosp Gen Juan Ramon Jimenez, Internal Med Serv, Huelva, Spain
Spanish Soc Internal Med, Multimorbid & Elderly Patients Grp, Murcia, Spain
Ramirez-Duque, N:
Hosp Univ Virgen Rocio, Internal Med Serv, Seville, Spain
Spanish Soc Internal Med, Multimorbid & Elderly Patients Grp, Murcia, Spain
Torres, OH:
Hosp Santa Cruz & San Pau, Internal Med Serv, Barcelona, Spain
Spanish Soc Internal Med, Multimorbid & Elderly Patients Grp, Murcia, Spain
Barbe, J:
Hosp Univ Vall Hebron, Internal Med Serv, Barcelona 08035, Spain
Univ Autonoma Barcelona, E-08193 Barcelona, Spain
Spanish Soc Internal Med, Multimorbid & Elderly Patients Grp, Murcia, Spain
Green Accepted
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