Advertisement

International Journal of Clinical Pharmacy

, Volume 37, Issue 1, pp 60–67 | Cite as

The impact of hospitalization on potentially inappropriate prescribing in an acute medical geriatric division

  • Dvora FrankenthalEmail author
  • Yaffa Lerman
  • Yehuda Lerman
Research Article

Abstract

Background Screening Tool of Older Person’s Prescriptions (STOPP) and the Screening Tool to Alert doctors to Right Treatment (START) have been increasingly used to evaluate potentially inappropriate prescriptions (PIPs) and potentially prescription omissions (PPOs). The impact of hospitalization on PIPs/PPOs has not been investigated in depth. Objective To compare the prevalence of PIPs/PPOs in elderly patients on hospital admission and discharge and to identify associated risk factors. Setting An acute medical geriatric division of the Tel Aviv Medical Center (Israel). Method This retrospective cross-sectional study included patients admitted from 12/2011 to 12/2012 aged ≥65 years. Data from patients’ records included demographic details, diagnoses and medications at admission and discharge. STOPP/START criteria were applied to each patient’s record. Main outcome measure Prevalence of PIPs/PPOs on hospital admission and discharge. Results Three hundred patients were included (mean ± SD age 81.9 ± 7.2 years). Admission PIPs prevalence was 39.3 % (118 patients, 172 PIPs) and it increased to 46.0 % (138 patients, 209 PIPs) at discharge (P = 0.009). Admission PPOs prevalence was 41.0 % (123 patients, 153 PPOs) and it decreased to 28.3 % (85 patients, 99 PPOs) at discharge (P < 0.001). Having at least one PIP/PPO at discharge but not at admission was associated with length of hospital stay (OR 1.02, 95 % CI 1.001–1.03). History of falls increased the risk of being a “new PIP patient” (OR 2.25, 95 % CI 1.03–4.9), whereas diabetes increased the risk of being a “new PPO patient” (OR 3.86, 95 % CI 1.2–12.5). Conclusion Hospitalization in a geriatric division resulted in an increase in PIPs and a decrease in PPOs. Strategies to reduce PIPs need to be implemented, especially for patients with longer hospital stay and a history of falls.

Keywords

Elderly Hospitalization Israel Medications START criteria STOPP criteria 

Notes

Acknowledgments

We would like to thank Mrs. Ilana Gelernter from the statistical laboratory in Tel Aviv University for her help in the statistical analysis.

Funding

None.

Conflicts of interest

The authors declare no conflicts of interest.

References

  1. 1.
    Hamilton HJ, Gallagher PF, O’Mahony D. Inappropriate prescribing and adverse drug events in older people. BMC Geriatr. 2009;28(9):5.CrossRefGoogle Scholar
  2. 2.
    Barry PJ, Gallagher P, Ryan C, O’mahony D. START (screening tool to alert doctors to the right treatment)—an evidence-based screening tool to detect prescribing omissions in elderly patients. Age Ageing. 2007;36:632–8.PubMedCrossRefGoogle Scholar
  3. 3.
    O’Connor MN, Gallagher P, O’Mahony D. Inappropriate prescribing: criteria, detection and prevention. Drugs Aging. 2012;29(6):437–52.PubMedCrossRefGoogle Scholar
  4. 4.
    Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D. STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46:72–83.PubMedCrossRefGoogle Scholar
  5. 5.
    Onatade R, Auyeung V, Scutt G, Fernando J. Potentially inappropriate prescribing in patients on admission and discharge from an older peoples’ unit of an acute UK hospital. Drugs Aging. 2013;30:729–37.PubMedCrossRefGoogle Scholar
  6. 6.
    Lang PO, Vogt-Ferrier N, Hasso Y, Le Saint L, Dramé M, Zekry D, et al. Interdisciplinary geriatric and psychiatric care reduces potentially inappropriate prescribing in the hospital: interventional study in 150 acutely ill elderly patients with mental and somatic comorbid conditions. J Am Med Dir Assoc. 2012;13:406.e1–7.CrossRefGoogle Scholar
  7. 7.
    Liu CL, Peng LN, Chen YT, Lin MH, Liu LK, Chen LK. Potentially inappropriate prescribing (IP) for elderly medical inpatients in Taiwan: a hospital-based study. Arch Gerontol Geriatr. 2012;55:148–51.PubMedCrossRefGoogle Scholar
  8. 8.
    Lang PO, Hasso Y, Dramé M, Vogt-Ferrier N, Prudent M, Gold G, et al. Potentially inappropriate prescribing including under-use amongst older patients with cognitive or psychiatric co-morbidities. Age Ageing. 2010;39:373–81.PubMedCrossRefGoogle Scholar
  9. 9.
    Mansur N, Weiss A, Beloosesky Y. Is there an association between inappropriate prescription drug use and adherence in discharged elderly patients? Ann Pharmacother. 2009;43:177–84.PubMedGoogle Scholar
  10. 10.
    Bakken MS, Ranhoff AH, Engeland A, Ruths S. Inappropriate prescribing for older people admitted to an intermediate-care nursing home unit and hospital wards. Scand J Prim Health Care. 2012;30:169–75.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Laroche ML, Charmes JP, Nouaille Y, Fourrier A, Merle L. Impact of hospitalisation in an acute medical geriatric unit on potentially inappropriate medication use. Drugs Aging. 2006;23:49–59.PubMedCrossRefGoogle Scholar
  12. 12.
    Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.PubMedCrossRefGoogle Scholar
  13. 13.
    Katz S, Downs TD, Cash HR, Grotz RC. Progress in development of the index of ADL. Gerontologist. 1970;10:20–30.PubMedCrossRefGoogle Scholar
  14. 14.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.PubMedCrossRefGoogle Scholar
  15. 15.
    Gallagher P, Omahony D. STOPP (Screening tool of older persons’ potentially inappropriate prescriptions): application to acutely ill elderly patients and comparison with Beers’ criteria. Age Ageing. 2008;37:673–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Wahab MS, Nyfort-Hansen K, Kowalski SR. Inappropriate prescribing in hospitalised Australian elderly as determined by the STOPP criteria. Int J Clin Pharm. 2012;34:855–62.PubMedCrossRefGoogle Scholar
  17. 17.
    Gallagher P, Lang PO, Cherubini A, Topinková E, Cruz-Jentoft A, Montero Errasquín B, et al. Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals. Eur J Clin Pharmacol. 2011;67:1175–88.PubMedCrossRefGoogle Scholar
  18. 18.
    Kane RL, Quslander JG, Abrass IB, Resnick B. Essentials of clinical geriatrics. 6th ed. New York: McGraw-Hill; 2009.Google Scholar
  19. 19.
    Morandi A, Vasilevskis E, Pandharipande PP, Girard TD, Solberg LM, Neal EB, et al. Inappropriate medication prescriptions in elderly adults surviving an intensive care unit hospitalization. J Am Geriatr Soc. 2013;61:1128–34.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Kanaan AO, Donovan JL, Duchin NP, Field TS, Tjia J, Cutrona SL, et al. Adverse drug events after hospital discharge in older adults: types, severity, and involvement of Beers criteria medications. J Am Geriatr Soc. 2013;61:1894–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Lam MP, Cheung BM. The use of STOPP/START criteria as a screening tool for assessing the appropriateness of medications in the elderly population. Expert Rev Clin Pharmacol. 2012;5:187–97.PubMedCrossRefGoogle Scholar
  22. 22.
    Dalleur O, Spinewine A, Henrard S, Losseau C, Speybroeck N, Boland B. Inappropriate prescribing and related hospital admissions in frail older persons according to the STOPP and START criteria. Drugs Aging. 2012;29:829–37.PubMedCrossRefGoogle Scholar
  23. 23.
    Hill-Taylor B, Sketris I, Hayden J, Byrne S, O’Sullivan D, Christie R. 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. J Clin Pharm Ther. 2013;38:360–72.PubMedCrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2014

Authors and Affiliations

  • Dvora Frankenthal
    • 1
    Email author
  • Yaffa Lerman
    • 1
    • 2
  • Yehuda Lerman
    • 1
  1. 1.School of Public Health, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  2. 2.Geriatric DivisionTel Aviv Sourasky Medical CenterTel AvivIsrael

Personalised recommendations