Potentially inappropriate prescribing in older hospitalized Dutch patients according to the STOPP/START criteria v2: a l
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PHARMACOEPIDEMIOLOGY AND PRESCRIPTION
Potentially inappropriate prescribing in older hospitalized Dutch patients according to the STOPP/START criteria v2: a longitudinal study Birgit A. Damoiseaux-Volman 1 & Stephanie Medlock 1 & Kimmy Raven 1 & Danielle Sent 1 & Johannes A. Romijn 2 & Nathalie van der Velde 3 & Ameen Abu-Hanna 1 Received: 30 July 2020 / Accepted: 20 November 2020 # The Author(s) 2020
Abstract Purpose To investigate prevalence, independent associations, and variation over time of potentially inappropriate prescriptions in a population of older hospitalized patients. Methods A longitudinal study using a large dataset of hospital admissions of older patients (≥ 70 years) based on an electronic health records cohort including data from 2015 to 2019. Potentially inappropriate medication (PIM) and potential prescribing omission (PPO) prevalence during hospital stay were identified based on the Dutch STOPP/START criteria v2. Univariate and multivariate logistic regression were used for analyzing associations and trends over time. Results The data included 16,687 admissions. Of all admissions, 56% had ≥ 1 PIM and 58% had ≥ 1 PPO. Gender, age, number of medications, number of diagnoses, Charlson score, and length of stay were independently associated with both PIMs and PPOs. Additionally, number of departments and number of prescribing specialties were independently associated with PIMs. Over the years, the PIM prevalence did not change (OR = 1.00, p = .95), whereas PPO prevalence increased (OR = 1.08, p < .001). However, when corrected for changes in patient characteristics such as number of diagnoses, the PIM (aOR = 0.91, p < .001) and PPO prevalence (aOR = 0.94, p < .001) decreased over the years. Conclusion We found potentially inappropriate prescriptions in the majority of admissions of older patients. Prescribing relatively improved over time when considering complexity of the admissions. Nevertheless, the high prevalence shows a clear need to better address this issue in clinical practice. Studies seeking effective (re)prescribing interventions are warranted. Keywords Inappropriate prescribing . Aged . Hospital . Older patients . Polypharmacy
Introduction
* Birgit A. Damoiseaux-Volman [email protected] 1
Amsterdam UMC, Department of Medical Informatics, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
2
Amsterdam UMC, Department of Medicine, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
3
Amsterdam UMC, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
Prescription of medications for older people is complex due to multimorbidity, polypharmacy, and age-specific changes in pharmacokinetics and pharmacodynamics [1, 2]. Most clinical guidelines contain treatment advice for single diseases and provide insufficient support for prescription of multiple drugs in olde
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