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Santos Garcia T, Simas da Rocha B, De Jezus Castro SM, Heineck I. Potentially inappropriate medications for older adults in a primary healthcare unit in southern Brazil. Int J Clin Pharm 2020; 42:911-922. [PMID: 32390088 DOI: 10.1007/s11096-020-01048-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 04/27/2020] [Indexed: 12/28/2022]
Abstract
Background Potentially inappropriate medications for older adults are those that offer more risks than benefits for this population. Such medications found in older adults' prescriptions across the world are associated with higher rates of comorbidities and hospitalizations, along with high expenditure on healthcare resources. Objectives To estimate the frequency of older adults using potentially inappropriate medications according to four different criteria, to identify factors associated with the use of such medicines and differences between the tools. Setting A primary healthcare unit linked to a university hospital in Porto Alegre, Brazil. Method This was a cross-sectional study conducted via data collection from the electronic medical records of 390 older adults. The information collected comprised sex, age, chronic diseases diagnosed and medications used. The dependent variable of the study was the use of at least one potentially inappropriate medication, according to the following criteria: Beers, Screening Tool of Older Persons' Prescriptions (STOPP), Brazilian consensus and Anticholinergic Risk Scale (ARS). Main outcome measurement Prevalence of inappropriate medication, differences between the tools and associated factors. Results: The use of at least one potentially inappropriate medication was found in 55.1% of the sample according to the Beers criterion, 51.3% according to the Brazilian consensus, 42.6% according to STOPP and 23.6% according to ARS. It was also seen that 14.9% of the studied population was exposed to a very strong anticholinergic risk. Depending on which tools were used, the agreement observed between the criteria was considered high, moderate, or low. Regarding the four criteria, the use of potentially inappropriate medication is associated with polypharmacy, the diagnosis of three or more chronic diseases and the presence of neuropsychiatric and musculoskeletal diseases. Conclusion Among the older adult population studied, the prevalence of potentially anappropriate medication is high, according to the four different classification criteria used. As a more specific tool, the agreement between Anticholinergic Risk Scale and other criteria was lower, but it can be an important complement to other lists.
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Affiliation(s)
- Taiane Santos Garcia
- Programa de Pós-Graduação em Assistência Farmacêutica, School of Pharmacy, Anexo I da Faculdade de Farmácia, Federal University of Rio Grande do Sul, R. São Luís, 150 - Santana, Porto Alegre, RS, 90620-170, Brazil.
| | - Bruno Simas da Rocha
- Graduate Program in Medical Sciences: Endocrinology, Clinical Pharmacy Section, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Bairro Santa Cecília, Porto Alegre, 90035-903, Brazil
| | - Stela Maris De Jezus Castro
- Department of Statistics, Institute of Mathematics and Statistics, Federal University of Rio Grande do Sul, Av. Bento Gonçalves, 9500 Prédio 43-111, Bairro Agronomia, Porto Alegre, 91509-900, Brazil
| | - Isabela Heineck
- Programa de Pós-Graduação em Assistência Farmacêutica, School of Pharmacy, Anexo I da Faculdade de Farmácia, Federal University of Rio Grande do Sul, R. São Luís, 150 - Santana, Porto Alegre, RS, 90620-170, Brazil
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Buda V, Prelipcean A, Andor M, Dehelean L, Dalleur O, Buda S, Spatar L, Mabda MC, Suciu M, Danciu C, Tudor A, Petrescu L, Cristescu C. Potentially Inappropriate Prescriptions in Ambulatory Elderly Patients Living in Rural Areas of Romania Using STOPP/START (Version 2) Criteria. Clin Interv Aging 2020; 15:407-417. [PMID: 32256055 PMCID: PMC7090181 DOI: 10.2147/cia.s233270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/29/2020] [Indexed: 01/17/2023] Open
Abstract
Background Rational use of medications and monitoring of prescriptions in elderly patients is important to decrease the number and duration of hospitalizations, emergency medical consultations, mortality, as well as medical costs. Purpose To identify potentially inappropriate medications (PIMs) and potential prescription omissions (PPOs), and determine their prevalence based on the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) v2 criteria and Screening Tool to Alert doctors to Right Treatment (START) v2 criteria for patients aged >65 years. Methods This cross-sectional study was conducted in two rural counties in Romania based on electronic prescriptions for chronic conditions (EPCCs) issued from 30 days to 90 days by a specialist or general practitioner. Collected EPCCs were evaluated by an interdisciplinary team of specialists based on 26 STOPP v2 criteria and 10 START v2 criteria. Results PIM prevalence was 25.80% and PPO prevalence was 41.72% for 646 EPCCs. The mean age of patients was 75 years and the mean number of drugs per EPCC was four. The most frequently identified PIMs were treatment duration (6.65%), theophylline administration (5.72%), drug indication (4.64%), cyclo-oxygenase-2 non-steroidal anti-inflammatory drugs (1.39%), and zopiclone prescription (0.77%). Statins (24.76%), beta-blockers (8.04%), and beta-2 agonist/antimuscarinic bronchodilators (5.88%) were the most frequently identified PPOs. Conclusion PPOs were more prevalent than PIMs for elderly populations living in the two rural counties in Romania we studied. Health practitioners (family physicians, specialists, and pharmacists) should focus on prophylactic and curative considerations when prescribing agents to decrease the morbidity and mortality of elderly rural Romanian patients.
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Affiliation(s)
- Valentina Buda
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Minodora Andor
- Department of Medical Semiotics, Faculty of Medicine, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
| | - Liana Dehelean
- Discipline of Psychiatry, Department of Neurosciences, Faculty of Medicine, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
| | - Olivia Dalleur
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain UCLouvain, Bruxelles, Belgium
| | - Simona Buda
- "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
| | - Lavinia Spatar
- "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
| | - Maria Cristiana Mabda
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
| | - Maria Suciu
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
| | - Corina Danciu
- Department of Pharmacognosy, Faculty of Pharmacy, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
| | - Anca Tudor
- Department of Statistics and Biomedical Informatics, Faculty of Pharmacy, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
| | - Lucian Petrescu
- Department of Cardiology VI, Faculty of Medicine, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania.,Cardiovascular Diseases Institute, Timisoara, Romania
| | - Carmen Cristescu
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
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