Reduction of Potentially Inappropriate Medications Using the STOPP Criteria in Frail Older Inpatients: A Randomised Controlled Study
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Hospital admissions may provide an opportunity to discontinue potentially inappropriate medications (PIMs) in older patients. Little is known about the effect of using the Screening Tool of Older People’s potentially inappropriate Prescriptions (STOPP) in this context. This study aimed to test the hypothesis that specific STOPP recommendations from an inpatient geriatric consultation team (IGCT) to the hospital physician leads to reductions in PIMs for patients at discharge.
This was a randomised controlled study in 146 frail inpatients (in 2011). The intervention consisted of STOPP recommendations made by the IGCT to ward physicians to discontinue PIMs, in addition to the standard geriatric advice.
Intervention (n = 74) and control (n = 72) groups were similar in terms of patient characteristics (median age 85 years; median number of daily drugs, seven) and PIM distribution (68 and 57 PIMs in 53 and 51 % of patients, respectively). At discharge, the reduction in PIMs was twice as high for the intervention group as for the control group (39.7 and 19.3 %, respectively; p = 0.013). The proportion of patients who still had one or more PIM at discharge did not differ between groups. In the 50 patients followed-up a year later, the majority of PIMs that had been stopped during hospitalisation had not been restarted after discharge (17/28; 61 %). The clinical relevance of PIMs identified at baseline in those patients was considered major (29 %), moderate (37 %), minor (5 %), deleterious (8 %), or not assessed (11 %). Discontinuation rate was not associated with clinical importance.
Specific STOPP recommendations provided to hospital physicians doubled the reduction of PIMs at discharge in frail older inpatients. To further improve the appropriateness of prescribing in older patients, clinicians should focus on the STOPP criteria that are of major clinical importance, and general practitioners should be actively involved.
KeywordsAdverse Drug Event Medication Review Clinical Pharmacist Comprehensive Geriatric Assessment Inappropriate Medication
O. Dalleur was funded by the Federal Public Service Health of the Belgian government as part of a national project on the implementation of clinical pharmacy in hospitals. O. Dalleur, B. Boland, C. Losseau, S. Henrard, D. Wouters, N. Speybroeck, J.M. Degryse and A. Spinewine have no conflicts of interest that are directly relevant to the content of this article. The researchers would like to thank the internal geriatric consultation team at the Cliniques universitaires Saint-Luc for their valuable contribution to data collection, and Ana Bastos, Barbara Sneyers and Rebecca Jones for their advice.
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