Potentially inappropriate drug prescribing in elderly hospitalized patients: an analysis and comparison of explicit criteria

Concetta Di Giorgio, Alessio Provenzani, Piera Polidori

Research output: Contribution to journalArticle

Abstract

Background The management of therapy in elderly is a critical aspect of primary care. The physio-pathological complexity of the elderly involves the prescription of multiple drugs, exposing them to a higher risk of adverse reactions. Objective Aim of this study was to assess the medication use and (potential) inappropriate medications and prescribing omissions in the elderly before and during hospitalization, according to the main tools in literature described, and their relation to the number of comorbidities. Setting The study was carried out by the Clinical Pharmacists at ISMETT, an Italian Research Institute. Methods The prescriptions of elderly, admitted in ISMETT between January and December 2012, were analyzed. The information about clinical profile of elderly and prescriptions was obtained from the electronic medical records. 2012 Beers criteria, Screening Tool of Older Person’s Prescriptions/Screening Tool to Alert doctors to Right Treatment criteria, and Improving Prescribing in the Elderly criteria were used to evaluate the appropriateness of prescriptions. The correlation between the number of comorbidities and the different tools was analyzed with the Spearman correlation coefficient. The frequency analysis was done with the Pearson Chi square test. Main outcome measure Percentage of potentially inappropriate medications and prescribing omissions before/during hospitalization in elderly. Results 1027 elderly were admitted between January and December 2012. At admission and during hospitalization, according to Beers criteria 24 and 49 % of elderly had at least one potentially inappropriate medication, respectively; according to the Screening Tool of Older Person’s Prescriptions criteria 21 and 27 %, respectively; according to the Improving Prescribing in the Elderly criteria 28 and 25 %, respectively; and then, according to Screening Tool to Alert doctors to Right Treatment criteria 28 and 33 % had at least one potentially prescribing omission, respectively. A significant correlation between comorbidities number and potentially inappropriate medications was found. Conclusion The number of potentially inappropriate medications globally increased during hospitalization. Statistical analysis showed that the comorbidity affects the level of inappropriate prescriptions. Specific tools can guide clinicians toward a more rational use of medicines and minimize probable complications related to multi-treatments.

Original languageEnglish
Pages (from-to)1-7
Number of pages7
JournalInternational Journal of Clinical Pharmacy
DOIs
Publication statusPublished - Apr 2016

Fingerprint

Inappropriate Prescribing
Drug Prescriptions
Pharmaceutical Preparations
Screening
Prescriptions
Comorbidity
Hospitalization
Patient Rights
Electronic medical equipment
Statistical methods
Prescription Drugs
Electronic Health Records
Chi-Square Distribution
Pharmacists
Potentially Inappropriate Medication List
Primary Health Care
Outcome Assessment (Health Care)

Keywords

  • Aging
  • Drug utilisation
  • Drug–drug interactions
  • Elderly
  • Hospital
  • Italy
  • Medicine use
  • Polypharmacy
  • Prescribing appropriateness index
  • Safety
  • Utilisation evaluation

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmaceutical Science
  • Pharmacology
  • Toxicology
  • Pharmacy

Cite this

@article{bbccc70fef7b454b80ae59efe0b43fd1,
title = "Potentially inappropriate drug prescribing in elderly hospitalized patients: an analysis and comparison of explicit criteria",
abstract = "Background The management of therapy in elderly is a critical aspect of primary care. The physio-pathological complexity of the elderly involves the prescription of multiple drugs, exposing them to a higher risk of adverse reactions. Objective Aim of this study was to assess the medication use and (potential) inappropriate medications and prescribing omissions in the elderly before and during hospitalization, according to the main tools in literature described, and their relation to the number of comorbidities. Setting The study was carried out by the Clinical Pharmacists at ISMETT, an Italian Research Institute. Methods The prescriptions of elderly, admitted in ISMETT between January and December 2012, were analyzed. The information about clinical profile of elderly and prescriptions was obtained from the electronic medical records. 2012 Beers criteria, Screening Tool of Older Person’s Prescriptions/Screening Tool to Alert doctors to Right Treatment criteria, and Improving Prescribing in the Elderly criteria were used to evaluate the appropriateness of prescriptions. The correlation between the number of comorbidities and the different tools was analyzed with the Spearman correlation coefficient. The frequency analysis was done with the Pearson Chi square test. Main outcome measure Percentage of potentially inappropriate medications and prescribing omissions before/during hospitalization in elderly. Results 1027 elderly were admitted between January and December 2012. At admission and during hospitalization, according to Beers criteria 24 and 49 {\%} of elderly had at least one potentially inappropriate medication, respectively; according to the Screening Tool of Older Person’s Prescriptions criteria 21 and 27 {\%}, respectively; according to the Improving Prescribing in the Elderly criteria 28 and 25 {\%}, respectively; and then, according to Screening Tool to Alert doctors to Right Treatment criteria 28 and 33 {\%} had at least one potentially prescribing omission, respectively. A significant correlation between comorbidities number and potentially inappropriate medications was found. Conclusion The number of potentially inappropriate medications globally increased during hospitalization. Statistical analysis showed that the comorbidity affects the level of inappropriate prescriptions. Specific tools can guide clinicians toward a more rational use of medicines and minimize probable complications related to multi-treatments.",
keywords = "Aging, Drug utilisation, Drug–drug interactions, Elderly, Hospital, Italy, Medicine use, Polypharmacy, Prescribing appropriateness index, Safety, Utilisation evaluation",
author = "{Di Giorgio}, Concetta and Alessio Provenzani and Piera Polidori",
year = "2016",
month = "4",
doi = "10.1007/s11096-016-0284-7",
language = "English",
pages = "1--7",
journal = "International Journal of Clinical Pharmacy",
issn = "2210-7703",
publisher = "Springer Netherlands",

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TY - JOUR

T1 - Potentially inappropriate drug prescribing in elderly hospitalized patients

T2 - an analysis and comparison of explicit criteria

AU - Di Giorgio, Concetta

AU - Provenzani, Alessio

AU - Polidori, Piera

PY - 2016/4

Y1 - 2016/4

N2 - Background The management of therapy in elderly is a critical aspect of primary care. The physio-pathological complexity of the elderly involves the prescription of multiple drugs, exposing them to a higher risk of adverse reactions. Objective Aim of this study was to assess the medication use and (potential) inappropriate medications and prescribing omissions in the elderly before and during hospitalization, according to the main tools in literature described, and their relation to the number of comorbidities. Setting The study was carried out by the Clinical Pharmacists at ISMETT, an Italian Research Institute. Methods The prescriptions of elderly, admitted in ISMETT between January and December 2012, were analyzed. The information about clinical profile of elderly and prescriptions was obtained from the electronic medical records. 2012 Beers criteria, Screening Tool of Older Person’s Prescriptions/Screening Tool to Alert doctors to Right Treatment criteria, and Improving Prescribing in the Elderly criteria were used to evaluate the appropriateness of prescriptions. The correlation between the number of comorbidities and the different tools was analyzed with the Spearman correlation coefficient. The frequency analysis was done with the Pearson Chi square test. Main outcome measure Percentage of potentially inappropriate medications and prescribing omissions before/during hospitalization in elderly. Results 1027 elderly were admitted between January and December 2012. At admission and during hospitalization, according to Beers criteria 24 and 49 % of elderly had at least one potentially inappropriate medication, respectively; according to the Screening Tool of Older Person’s Prescriptions criteria 21 and 27 %, respectively; according to the Improving Prescribing in the Elderly criteria 28 and 25 %, respectively; and then, according to Screening Tool to Alert doctors to Right Treatment criteria 28 and 33 % had at least one potentially prescribing omission, respectively. A significant correlation between comorbidities number and potentially inappropriate medications was found. Conclusion The number of potentially inappropriate medications globally increased during hospitalization. Statistical analysis showed that the comorbidity affects the level of inappropriate prescriptions. Specific tools can guide clinicians toward a more rational use of medicines and minimize probable complications related to multi-treatments.

AB - Background The management of therapy in elderly is a critical aspect of primary care. The physio-pathological complexity of the elderly involves the prescription of multiple drugs, exposing them to a higher risk of adverse reactions. Objective Aim of this study was to assess the medication use and (potential) inappropriate medications and prescribing omissions in the elderly before and during hospitalization, according to the main tools in literature described, and their relation to the number of comorbidities. Setting The study was carried out by the Clinical Pharmacists at ISMETT, an Italian Research Institute. Methods The prescriptions of elderly, admitted in ISMETT between January and December 2012, were analyzed. The information about clinical profile of elderly and prescriptions was obtained from the electronic medical records. 2012 Beers criteria, Screening Tool of Older Person’s Prescriptions/Screening Tool to Alert doctors to Right Treatment criteria, and Improving Prescribing in the Elderly criteria were used to evaluate the appropriateness of prescriptions. The correlation between the number of comorbidities and the different tools was analyzed with the Spearman correlation coefficient. The frequency analysis was done with the Pearson Chi square test. Main outcome measure Percentage of potentially inappropriate medications and prescribing omissions before/during hospitalization in elderly. Results 1027 elderly were admitted between January and December 2012. At admission and during hospitalization, according to Beers criteria 24 and 49 % of elderly had at least one potentially inappropriate medication, respectively; according to the Screening Tool of Older Person’s Prescriptions criteria 21 and 27 %, respectively; according to the Improving Prescribing in the Elderly criteria 28 and 25 %, respectively; and then, according to Screening Tool to Alert doctors to Right Treatment criteria 28 and 33 % had at least one potentially prescribing omission, respectively. A significant correlation between comorbidities number and potentially inappropriate medications was found. Conclusion The number of potentially inappropriate medications globally increased during hospitalization. Statistical analysis showed that the comorbidity affects the level of inappropriate prescriptions. Specific tools can guide clinicians toward a more rational use of medicines and minimize probable complications related to multi-treatments.

KW - Aging

KW - Drug utilisation

KW - Drug–drug interactions

KW - Elderly

KW - Hospital

KW - Italy

KW - Medicine use

KW - Polypharmacy

KW - Prescribing appropriateness index

KW - Safety

KW - Utilisation evaluation

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