Skip to main content

Advertisement

SpringerLink
Log in

Potentially inappropriate prescribing and associated factors in elderly patients at hospital discharge in Brazil: a cross-sectional study

  • Research Article
  • Published:
International Journal of Clinical Pharmacy Aims and scope Submit manuscript

Abstract

Background The Screening Tool of Older Persons’ Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) criteria is used to identify instances of potentially inappropriate prescribing in a patient’s medication regimen. Objective To determine the prevalence and predictors of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) among elderly patients at hospital discharge. Setting A university hospital medical clinic in Brazil. Method Discharge prescriptions were examined using the STOPP/START criteria. Subjects were inpatients aged ≥60 years receiving at least one medication prior to hospitalization and with a history of cardiovascular disease. The prevalence of PIMs and PPOs was determined and a multivariable binary regression analysis was performed to identify independent predictors associated with PIMs or PPOs. Main outcome measure Prevalence of PIMs and PPOs. Results Of the 230 subjects, 13.9% were prescribed at least one PIM. The most frequently prescribed PIMs were glibenclamide or chlorpropamide prescribed for type 2 diabetes mellitus (31.0%), and aspirin at doses >150 mg/day (14.3%). Ninety patients had at least one PPO (39.1%). The most prevalent PPOs were statins (29.8%) and antiplatelet therapy (13.7%) for diabetes mellitus when coexisting major cardiovascular risk factors were present. No predictors for PIMs were found. In contrast, diabetes was a risk factor while dyslipidaemia was a protective factor for PPOs. Conclusion PIMs and PPOs commonly occur with elderly people at hospital discharge. Diabetes and dyslipidaemia were significantly associated with PPOs. Our findings show the need for interventions to reduce potentially inappropriate prescribing, such as a pharmacist medication review process at hospital discharge.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. United Nations. World Population Ageing 2013. In: Department of Economic and Social Affairs: Population Division. United Nation. 2013. http://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2013.pdf. Accessed 11 Aug 2016.

  2. Brasil. Censo demográfico 2010. In: População. Instituto Brasileiro de Geografia e Estatística. 2010. http://www.ibge.gov.br/home/estatistica/populacao/censo2010/default.shtm. Accessed 11 Aug 2016.

  3. Brasil. Projeção da população do Brasil por sexo e idade: 2000-2060. In: Projeção da população. Instituto Brasileiro de Geografia e Estatística. 2010. http://www.ibge.gov.br/home/estatistica/populacao/projecao_da_populacao/2013/default.shtm. Accessed 11 Aug 2016.

  4. Crome P. What’s different about older people. Toxicology. 2003;192(1):49–54.

    Article  CAS  PubMed  Google Scholar 

  5. Marengoni A, Pasina L, Concoreggi C, Martini G, Brognoli F, Nobili A, et al. Understanding adverse drug reactions in older adults through drug–drug interactions. Eur J Intern Med. 2014;25:843–6.

    Article  CAS  PubMed  Google Scholar 

  6. Franchi C, Nobili A, Mari D, Tettamanti M, Djade CD, Pasina L, et al. Risk factors for hospital readmission of elderly patients. Eur J Intern Med. 2013;24(1):45–51.

    Article  PubMed  Google Scholar 

  7. Fick DM, Cooper JW, Wade W, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults—results of a US consensus panel of experts. Arch Intern Med. 2003;163:2716–24.

    Article  PubMed  Google Scholar 

  8. AGS 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–46.

    Article  Google Scholar 

  9. Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D. STOPP (Screening Tool of Older Person’s Prescription) and START (Screening Tool to Alert doctors to Right Treatment): consensus validation. Int J Clin Pharmacol Ther. 2008;46(2):72–83.

    Article  CAS  PubMed  Google Scholar 

  10. Gallagher P, O’Mahony 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(6):673–9.

    Article  PubMed  Google Scholar 

  11. Ubeda A, Ferrándiz L, Maicas N, Gomez C, Bonet M, Peris JE. Potentially inappropriate prescribing in institutionalised older patients in Spain: the STOPP-START criteria compared with the Beers criteria. Pharm Pract (Granada). 2012;10(2):83–91.

    Article  Google Scholar 

  12. Bolanda B, Guignard B, Dalleure O, Lang PO. Application of STOPP/START and Beers criteria: compared analysis on identification and relevance of potentially inappropriate prescriptions. Eur Geriatr Med. 2016;7(5):416–23.

    Article  Google Scholar 

  13. Nascimento MMG, Ribeiro AQ, Pereira ML, Soares AC, Loyola Filho AI, Dias-Júnior CAC. Identification of inappropriate prescribing in a Brazilian nursing home using STOPP/START screening tools and the Beers’ Criteria. BJPS. 2014;50(4):911–8.

    Google Scholar 

  14. Oliveira MG, Amorim WW, De Jesus SR, Heine JM, Coqueiro HL, Passos LC. A comparison of the beers criteria and STOPP criteria for identifying the use of potentially inappropriate medications among elderly patients in primary care. J Eval Clin Pract. 2015;21:320–5.

    Article  PubMed  Google Scholar 

  15. Martins GA, Acurcio FA, Franceschini SCC, Priore SE, Ribeiro AQ. Uso de medicamentos potencialmente inadequados entre idosos do Município de Viçosa, Minas Gerais, Brasil: um inquérito de base populacional. Cad Saude Pública. 2015;31(11):2401–12.

    Article  PubMed  Google Scholar 

  16. O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44(2):213–8.

    Article  PubMed  Google Scholar 

  17. Gosh M, Wortz M, Nicholas JA, Doshi HK, Kammerlander C, Lechleitner M. Inappropriate prescribing as a predictor for long-term mortality after hip fracture. Gerontology. 2014;60:114–22.

    Article  Google Scholar 

  18. Frankenthal D, Lerman Y, Kalendaryev E, Lerman Y. Potentially inappropriate prescribing among older residents in a geriatric hospital in Israel. Int J Clin Pharm. 2013;35:677–82.

    Article  PubMed  Google Scholar 

  19. Lee S, Cho S, Lee YJ, Choi J, Ga H, Kim Y, et al. Survey of potentially inappropriate prescription using STOPP/START criteria in Inha University Hospital. Korean J Fam Med. 2013;24:319–26.

    Article  Google Scholar 

  20. Liu C, Peng L, Chen Y, Lin M, Liu L, Chen L. Potentially inappropriate prescribing (IP) for elderly medical in patients in Taiwan: a hospital-based study. Arc Gerontol Geriatr. 2012;55:148–51.

    Article  Google Scholar 

  21. Chan SP, Colagiuri S. Systematic review and meta-analysis of the efficacy and hypoglycemic safety of gliclazide versus other insulinotropic agents. Diabetes Res Clin Pract. 2015;110:75–81.

    Article  CAS  PubMed  Google Scholar 

  22. Tamura T, Sakaeda T, Kadoyama K, Okuno Y. Aspirin- and clopidogrel-associated bleeding complications: data mining of the public version of the FDA adverse event reporting system, AERS. Int J Med Sci. 2012;9(6):441–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Magin P, Goode S, Pond D. GPs, medications and older people: a qualitative study of general practitioners’ approaches to potentially inappropriate medications in older people. Australas J Ageing. 2015;34(2):134–9.

    Article  PubMed  Google Scholar 

  24. Brasil. Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Assistência Farmacêutica e Insumos Estratégicos. Relação Nacional de Medicamentos Essenciais: RENAME 2014/Ministério da Saúde, Secretaria de Ciência, Tecnologia e Insumos Estratégicos, Departamento de Assistência Farmacêutica e Insumos Estratégicos. – 9. ed. rev. e atual. – Brasília: Ministério da Saúde, 2015.

  25. Guidoni CM, Borges APS, Freitas O, Pereira LRL. Prescription patterns for diabetes mellitus and therapeutic implications: a population-based analysis. Arq Bras Endocrinol Metab. 2012;56(2):120–7.

    Google Scholar 

  26. Chen LL, Tangiisuran B, Shafie AA, Hassali MAA. Evaluation of potentially inappropriate medications among elderly older residents of Malaysian nursing homes. Int J Clin Pharm. 2012;34:596–603.

    Article  CAS  PubMed  Google Scholar 

  27. Frély A, Chazard E, Pansu A, Beuscart J, Puisieux F. Impact of acute geriatric care in elderly patients according to the Screening Tool of Older Persons’ Prescriptions/Screening Tool to Alert doctors to Right Treatment criteria in northern France. Geriatr Gerontol Int. 2016;16:272–8.

    Article  PubMed  Google Scholar 

  28. Kovacevic SV, Simisic M, Rudinski SS, Culafic M, Vucicevic K, Prostran M, et al. Potentially inappropriate prescribing in older primary care patients. PLoS ONE. 2014;4:e95536.

    Article  Google Scholar 

  29. Yeste-Gómez I, Durán-García ME, Muiño-Miguez A, Gómez-Antúnez M, López-Berastegui O, Sanjurjo-Sáez M. Prescripciones potencialmente inapropiadas en el tratamiento ambulatorio de pacientes ancianos. Rev Calid Asist. 2014;29(1):22–8.

    Article  PubMed  Google Scholar 

  30. Lozano-Montoya I, Vélez-Diaz-Pallarés M, Delgado-Silveira E, Montero-Errasquin B, Jentoft AJC. Potentially inappropriate prescribing detected by STOPP–START criteria: are they really inappropriate? Age Ageing. 2015;44(5):861–6.

    Article  PubMed  Google Scholar 

  31. Projovic I, Vukadinovic D, Milovanovic O, Jurisevic M, Pavlovic R, Jacovic S, et al. Risk factors for potentially inappropriate prescribing to older patients in primary care. Eur J Clin Pharmacol. 2016;72:93–107.

    Article  PubMed  Google Scholar 

  32. Galván-Banqueri M, González-Méndez AI, Alfaro-Lara ER, Nieto-Martín MD, Pérez-Guerrero C, Santos-Ramos B. Evaluación de la adecuación del tratamiento farmacológico en pacientes pluripatológicos. Aten Primaria. 2013;45(5):235–43.

    Article  PubMed  Google Scholar 

  33. Gnjudic D, Hilmer SN, Blyth FM, Naganathan V, Waite L, Seibel MJ, et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol. 2012;65:989–95.

    Article  Google Scholar 

  34. Hamano J, Tokuda Y. Inappropriate prescribing among elderly home care patients in Japan: prevalence and risk factors. J Prim Care Community Health. 2014;5:90–6.

    Article  PubMed  Google Scholar 

  35. Laugaland K, Aase K, Barach P. Interventions to improve patient safety in transitional care—a review of the evidence. Work. 2012;41(Suppl 1):2915–24.

    PubMed  Google Scholar 

  36. Endres HG, Kaufmann-Kolle P, Steeb V, Bauer E, Böttner C, Thürmann P. Association between potentially inappropriate medication (PIM) use and risk of hospitalization in older adults: an observational study based on routine data comparing PIM use with use of PIM alternatives. PLoS ONE. 2016;11(2):e0146811.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Cahir C, Bennett K, Teljeur C, Fahey T. Potentially inappropriate prescribing and adverse health outcomes in community dwelling older patients. Br J Clin Pharmacol. 2014;77(1):201–10.

    Article  PubMed  Google Scholar 

  38. Gillespie U, Alassaad A, Hammarlund-Udenaes M, Mörlin C, Henrohn D, Bertilsson M, et al. Effects of pharmacists’ interventions on appropriateness of prescribing and evaluation of the instruments’ (MAI, STOPP and STARTs’) ability to predict hospitalization–analyses from a randomized controlled trial. PLoS ONE. 2013;8(5):e62401.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Alassaad A, Bertilsson M, Gillespie U, Sundström J, Hammarlund-Udenaes M, Melhus H. The effects of pharmacist intervention on emergency department visits in patients 80 years and older: subgroup analyses by number of prescribed drugs and appropriate prescribing. PLoS ONE. 2014;9(11):e111797.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Ryan C, O’Mahony D, O’Donovan DO, O’Grady E, Weedle P, Kennedy J, et al. A comparison of the application of STOPP/START to patients’drug lists with and without clinical information. Int J Clin Pharm. 2013;35:230–5.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Authors wish to thank all professionals and patients involved direct or indirectly with this study.

Funding

None.

Conflicts of interest

The authors have no conflict of interest to declare.

Author information

Authors and Affiliations

  1. Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil

    Ana Luiza Pereira Moreira Mori, Renata Cunha Carvalho, Patricia Melo Aguiar, Maria Goretti Farias de Lima, Magali da Silva Pacheco Nobre Rossi, José Fernando Salvador Carrillo & Sílvia Storpirtis

  2. University Hospital, University of São Paulo, São Paulo, Brazil

    Egídio Lima Dórea

Authors
  1. Ana Luiza Pereira Moreira Mori
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Renata Cunha Carvalho
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patricia Melo Aguiar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maria Goretti Farias de Lima
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Magali da Silva Pacheco Nobre Rossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. José Fernando Salvador Carrillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Egídio Lima Dórea
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sílvia Storpirtis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Patricia Melo Aguiar.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mori, A.L.P.M., Carvalho, R.C., Aguiar, P.M. et al. Potentially inappropriate prescribing and associated factors in elderly patients at hospital discharge in Brazil: a cross-sectional study. Int J Clin Pharm 39, 386–393 (2017). https://doi.org/10.1007/s11096-017-0433-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-017-0433-7

Keywords

Search

Navigation