Prescripción potencialmente inadecuada en patología cardiovascular en pacientes ancianos en atención primaria  <span class="so-article-trans-title" dir="auto"> Translated title: Potentially inappropriate prescription in cardiovascular pathology in elderly patients in primary care </span>

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Abstract

RESUMEN Objetivo: Estudiar en pacientes mayores de 65 años las prescripciones potencialmente inapropiadas y omisiones de prescripción en patología cardiovascular en atención primaria. Metodología: Estudio descriptivo transversal en un centro de salud urbano utilizando la versión 2 de los criterios STOPP-START. Resultados: En los 170 pacientes incluidos (62,4% mujeres; mediana de edad, 79 años) hubo un 15,3% de prescripciones potencialmente inapropiadas y un 8,8% de omisiones de prescripción. El 72,9% tenía más de 4 enfermedades y el 57,1% tomaba más de 4 fármacos. A mayor pluripatología, mayor consumo de fármacos, sin relación entre las prescripciones potencialmente inapropiadas y las características epidemiológicas y clínicas de los pacientes. Conclusiones: Los criterios STOPP-START son útiles para revisar la prescripción en personas mayores de 65 años con enfermedades cardiovasculares entre su pluripatología.

Translated abstract

ABSTRACT Objective: To study potentially inappropriate prescriptions and prescription omissions in cardiovascular pathology in primary care in patients older than 65 years old. Methodology: Descriptive cross-sectional study in an urban primary health center using version 2 of STOPP-START criteria. Results: 170 patients included, 62.4% women, overage 79 years old, there were 15.3% potentially inappropriate prescriptions and 8.8% prescription omissions. 72.9% had more than 4 diseases and 57.1% took more than 4 drugs. The more diseases, the more consumption of drugs, without relation between potentially inappropriate prescriptions and the epidemiological and clinical characteristics of the patients. Conclusions: STOPP-START criteria are useful for reviewing prescription in people over 65 with cardiovascular disease among their pluripatology.

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Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy.

Doron Garfinkel, Derelie Mangin (2010)

Polypharmacy and inappropriate medication use is a problem in elderly patients, who are more likely to experience adverse effects from multiple treatments and less likely to obtain the same therapeutic benefit as younger populations. The Good Palliative-Geriatric Practice algorithm for drug discontinuation has been shown to be effective in reducing polypharmacy and improving mortality and morbidity in nursing home inpatients. This study reports the feasibility of this approach in community-dwelling older patients. The Good Palliative-Geriatric Practice algorithm was applied to a cohort of 70 community-dwelling older patients to recommend drug discontinuations. Success rates of discontinuation, morbidity, mortality, and changes in health status were recorded. The mean (SD) age of the 70 patients was 82.8 (6.9) years. Forty-three patients (61%) had 3 or more and 26% had 5 or more comorbidities. The mean follow-up was 19 months. Participants used a mean (SD) of 7.7 (3.7) medications. Protocol indicated that discontinuation was recommended for 311 medications in 64 patients (58% of drugs; mean [SD], 4.4 [2.5] drugs per patient overall, 4.9 per patient who had discontinuation). Of the discontinued drug therapies, 2% were restarted because of recurrence of the original indication. Taking nonconsent and failures together, successful discontinuation was achieved in 81%. Ten elderly patients (14%) died after a mean follow-up of 13 months, with the mean age at death of 89 years. No significant adverse events or deaths were attributable to discontinuation, and 88% of patients reported global improvement in health. It is feasible to decrease medication burden in community-dwelling elderly patients. This tool would be suitable for larger randomized controlled trials in different clinical settings.

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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.

Joshua R. Christie, S Byrne, Matthew Hayden … (2013)

Potentially inappropriate prescribing (PIP) has significant clinical, humanistic and economic impacts. Identifying PIP in older adults may reduce their burden of adverse drug events. Tools with explicit criteria are being developed to screen for PIP in this population. These tools vary in their ability to identify PIP in specific care settings and jurisdictions due to such factors as local prescribing practices and formularies. One promising set of screening tools are the STOPP (Screening Tool of Older Person's potentially inappropriate Prescriptions) and START (Screening Tool of Alert doctors to the Right Treatment) criteria. We conducted a systematic review of research studies that describe the application of the STOPP/START criteria and examined the evidence of the impact of STOPP/START on clinical, humanistic and economic outcomes in older adults. We performed a systematic review of studies from relevant biomedical databases and grey literature sources published from January 2007 to January 2012. We searched citation and reference lists and contacted content experts to identify additional studies. Two authors independently selected studies using a predefined protocol. We did not restrict selection to particular study designs; however, non-English studies were excluded during the selection process. Independent extraction of articles by two authors used predefined data fields. For randomized controlled trials and observational studies comparing STOPP/START to other explicit criteria, we assessed risk of bias using an adapted tool. We included 13 studies: a single randomized controlled trial and 12 observational studies. We performed a descriptive analysis as heterogeneity of study populations, interventions and study design precluded meta-analysis. All observational studies reported the prevalence of PIP; however, the application of the criteria was not consistent across all studies. Seven of the observational studies compared STOPP/START with other explicit criteria. The STOPP/START criteria were reported to be more sensitive than the more-frequently-cited Beers criteria in six studies, but less sensitive than a set of criteria developed in Australia. The STOPP criteria identified more medications associated with adverse drug events than the 2002 version of the Beers criteria. Patients with PIP, as identified by STOPP, had an 85% increased risk of adverse drug events in one study (OR = 1·85, 95% CI: 1·51-2·26; P < 0·001). There was limited evidence that the application of STOPP/START criteria optimized prescribing. Research involving the application of STOPP/START on the impact on the quality of life was not found. The direct costs of PIP were documented in three studies from Ireland, but more extensive analyses on the economic impact or studies from other jurisdictions were not found. The STOPP/START criteria have been used to review the medication profiles of community-dwelling, acute care and long-term care older patients in Europe, Asia and North America. Observational studies have reported the prevalence and predictors of PIP. The STOPP/START criteria appear to be more sensitive than the 2002 version of the Beers criteria. Limited evidence was found related to the clinical and economic impact of the STOPP/START criteria. © 2013 John Wiley & Sons Ltd.

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Effectiveness of the STOPP/START (Screening Tool of Older Persons' potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment) criteria: systematic review and meta-analysis of randomized controlled studies

S. Stewart, I. Sketris, J. Hayden … (2016)

STOPP/START are explicit screening tools that identify potentially inappropriate prescribing in older adults. Our objective was to update our 2013 systematic review that showed limited evidence of impact, using new evidence from randomized controlled trials (RCTs) assessing clinical, humanistic and economic outcomes in older adults.

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Author and article information

Journal

Journal ID (publisher-id): geroko

Title: Gerokomos

Abbreviated Title: Gerokomos

Publisher: Sociedad Española de Enfermería Geriátrica y Gerontológica (Barcelona, Barcelona, Spain )

ISSN (Print): 1134-928X

Publication date (Print and electronic): 2021

Volume: 32

Issue: 3

Pages: 164-167

Affiliations

[1] Ourense orgnameCentro de Salud Novoa Santos España

[2] Ourense orgnameCentro de Salud Novoa Santos España

Article

Publisher ID: S1134-928X2021000400006 Publisher ID: S1134-928X(21)03200300006

SO-VID: 319ea1f4-dafc-4b6a-b1af-59bfb471dc1e

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This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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Date received : 02 December 2019

Date accepted : 11 February 2020

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Figures: 0, Tables: 0, Equations: 0, References: 15, Pages: 4

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Prescripción potencialmente inadecuada en patología cardiovascular en pacientes ancianos en atención primaria Translated title: Potentially inappropriate prescription in cardiovascular pathology in elderly patients in primary care

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Most cited references 15

Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy.

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.

Effectiveness of the STOPP/START (Screening Tool of Older Persons' potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment) criteria: systematic review and meta-analysis of randomized controlled studies

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