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The Association Between Potentially Inappropriate Prescribing and Medication-Related Hospital Admissions in Older Patients: A Nested Case Control Study

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Abstract

Introduction

Medication-related problems can cause serious adverse drug events (ADEs) that may lead to hospitalization of the patient. There are multiple screening methods to detect and reduce potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). Whether this will result in less medication-related hospitalizations is unknown. The study objective was to assess the risk of preventable medication-related hospital admissions associated with potentially inappropriate prescribing, using the Beers 2012 and the Screening Tool of Older Person’s Prescriptions and the Screening Tool to Alert doctors to Right Treatment (STOPP & START) 2008 criteria.

Design, setting and participants

A nested case–control study was conducted with a subset of Dutch participants from the Hospital Admissions Related to Medication (HARM) study. Cases were defined as patients aged ≥65 years with a potentially preventable medication-related hospital admission. For each case, one control was selected, matched for age and sex. The primary determinant was the presence of one or more PIMs according to the Beers 2012 and STOPP 2008 criteria. The secondary determinant was the presence of one or more PIMs and PPOs according to the STOPP & START 2008 criteria. The strength of the association between inappropriate prescribing and medication-related hospital admission was evaluated with multivariate logistic regression and expressed as odds ratios (ORs) with 95 % confidence intervals (CIs).

Results

The prevalence of Beers 2012 criteria PIMs in the total cohort was 44.4 %. The prevalence of STOPP & START 2008 criteria PIMs and PPOs were, respectively, 34.1 and 57.7 %. STOPP 2008 criteria PIMs were associated with preventable medication-related hospital admissions [OR adjusted for number of drugs and comorbidities (ORadj) 2.30, 95 % CI 1.30–4.07], whereas there was no association with Beers 2012 criteria PIMs (ORadj 1.49, 95 % CI 0.90–2.47). STOPP PIMs and START PPOs together were also associated with preventable medication-related hospital admissions (ORadj 3.47, 95 % CI 1.70–7.09).

Conclusion

Our study shows that patients with potentially inappropriate prescribing detected with the STOPP & START 2008 criteria are at risk of preventable medication-related hospital admissions. The STOPP & START 2008 criteria can be used to identify older people at risk of medication-related problems.

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References

  1. Beijer HJ, de Blaey CJ. Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies. Pharm World Sci. 2002;24(2):46–54.

    Article  PubMed  CAS  Google Scholar 

  2. Alhawassi TM, Krass I, Bajorek BV, Pont LG. A systematic review of the prevalence and risk factors for adverse drug reactions in the elderly in the acute care setting. Clin Interv Aging. 2014;9:2079–86.

    PubMed  PubMed Central  Google Scholar 

  3. Leendertse AJ, Egberts AC, Stoker LJ, van den Bemt PM, HARM Study Group. Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch Intern Med. 2008;168(17):1890–6.

    PubMed  Google Scholar 

  4. Multidisciplinaire richtlijn 'Polyfarmacie bij ouderen'. Utrecht: Nederlands Huisartsen Genootschap. 2012.

  5. American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society Updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31.

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

    Article  PubMed  CAS  Google Scholar 

  7. Ryan C, O’Mahony D, Byrne S. Application of STOPP and START criteria: interrater reliability among pharmacists. Ann Pharmacother. 2009;43(7):1239–44.

    Article  PubMed  Google Scholar 

  8. 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  PubMed Central  Google Scholar 

  9. Ryan C, O’Mahony D, Kennedy J, Weedle P, Byrne S. Potentially inappropriate prescribing in an Irish elderly population in primary care. Br J Clin Pharmacol. 2009;68(6):936–47.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gallagher P, Lang PO, Cherubini A, Topinkova E, Cruz-Jentoft A, Montero Errasquin B, et al. Prevalence of potentially inappropriate prescribing in acutely ill population of older patients. admitted to six European hospitals. Eur J Clin Pharmacol. 2011;67(11):1175–88.

    Article  PubMed  Google Scholar 

  11. Curtain CM, Bindoff IK, Westbury JL, Peterson GM. A comparison of prescribing criteria when applied to older community-based patients. Drugs Aging. 2013;30(11):935–43.

    Article  PubMed  Google Scholar 

  12. Hill-Taylor B, Sketris I, Hayden J, Byrne S, O’Sullivan D, Christie R. 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. J Clin Pharm Ther. 2013;38(5):360–72.

    Article  PubMed  CAS  Google Scholar 

  13. Tosato M, Landi F, Martone A, Cherubinin A, Corsonello A, Volpato S, et al. Potentially inappropriate drug use among hospitalised older adults: results from the CRIME study. Age Ageing. 2014;43(6):767–73.

    Article  PubMed  Google Scholar 

  14. Hudhra K, García-Caballos M, Jucja B, Casado-Fernández E, Espigares-Rodriguez E, Bueno-Cavanillas A. Frequency of potentially inappropriate prescriptions in older people at discharge according to Beers and STOPP criteria. Int J Clin Pharm. 2014;36(3):596–603.

    Article  PubMed  Google Scholar 

  15. Hamilton H, Gallagher P, Ryan C, Byrne S, O’Mahony D. Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients. Arch Intern Med. 2011;171(11):1013–9.

    Article  PubMed  Google Scholar 

  16. 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 

  17. Albert SM, Colombi A, Hanlon J. Potentially inappropriate medications and risk of hospitalization in retirees. Drugs Aging. 2010;27(5):407–15.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Price SD, Holman CD, Sanfilippo FM, Emery JD. Are High-care nursing home residents at greater risk of unplanned hospital admission than other elderly patients when exposed to Beers potentially inappropriate medications. Geriatr Gerontol Int. 2014;14(4):934–41.

    Article  PubMed  Google Scholar 

  19. Price SD, Holman CD, Sanfilippo FM, Emery JD. Association between potentially inappropriate medications from the Beers criteria and the risk of unplanned hospitalization in elderly patients. Ann Pharmacother. 2014;48(1):6–16.

    Article  PubMed  Google Scholar 

  20. Dalleur O, Spinewine A, Henrard S, Losseau C, Speybroeck N, Boland B. Inappropriate prescribing and related hospital admissions in frail older persons according to the STOPP and START criteria. Drugs Aging. 2012;29(10):829–37.

    Article  PubMed  Google Scholar 

  21. Aronson JK. Meyler’s Side effects of drugs: the international encyclopedia of adverse drug reactions and interactions. 14th ed. Amsterdam: Elsevier; 2000.

  22. Kramer MS, Leventhal JM, Hutchinson TA, Feinstein AR. An algorithm for the operational assessment of adverse drug reactions. I. Background, description, and instructions for use. JAMA. 1979;242(7):623–32.

    Article  PubMed  CAS  Google Scholar 

  23. Schumock GT, Thornton JP. Focusing on the preventability of adverse drug reactions. Hosp Pharm. 1992;27(6):538.

    PubMed  CAS  Google Scholar 

  24. Vermeulen Windsant-van den Tweel AM, Verduijn MM, Derijks HJ, van Marum RJ. Detectie van ongeschikt medicatiegebruik bij ouderen. Worden de STOPP- en START-criteria de nieuwe standaard? Ned Tijdschr Geneeskd. 2012;156:A5076.

    PubMed  Google Scholar 

  25. Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006;145(4):247–54.

    Article  PubMed  CAS  Google Scholar 

  26. Twisk JWR. Applied multilevel analysis Cambridge. 1st ed. Cambridge: Cambridge University Press; 2006.

    Book  Google Scholar 

  27. Hill-Taylor B, Sketris I, Hayden J, Byrne S, O’Sullivan D, Christie R. 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. J Clin Pharm Ther. 2013;38(5):360–72.

    Article  PubMed  CAS  Google Scholar 

  28. Cahir C, Moriarty F, Teljeur C, Fahey T, Bennett K. Potentially inappropriate prescribing and vulnerability and hospitalization in older community-dwelling patients. Ann Pharmacother. 2014;48(12):1546–54.

    Article  PubMed  Google Scholar 

  29. Pasina L, Djade CD, Tettamanti M, Franchi C, Salerno F, Corrao S, et al. Prevalence of potentially inappropriate medications and risk of adverse clinical outcome in a cohort of hospitalized elderly patients: results from the REPOSI study. J Clin Pharm Ther. 2014;39(5):511–5.

    Article  PubMed  CAS  Google Scholar 

  30. Curtain CM, Bindoff IK, Westbury JL, Peterson GM. A comparison of prescribing criteria when applied to older community-based patients. Drugs Aging. 2013;30(11):935–43.

    Article  PubMed  Google Scholar 

  31. Castillo-Páramo A, Clavería A, Verdejo González A, Rey Gomez-Serranillos I, Fernandez-Merino MC, Figueiras A. Inappropriate prescribing according to the STOPP/START criteria in older people form a primary care setting. Eur J Gen Pract. 2014;20(4):281–9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Clinical Pharmacy, ZANOB, Jeroen Bosch Hospital, PO Box 3406, 5203 DK, ‘s-Hertogenbosch, The Netherlands

    C. A. K. van der Stelt, A. M. A. Vermeulen Windsant-van den Tweel, W. A. J. J. Hermens & H. J. Derijks

  2. Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands

    A. C. G. Egberts & H. J. Derijks

  3. Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands

    A. C. G. Egberts

  4. Department of Clinical Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands

    P. M. L. A. van den Bemt

  5. Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands

    A. J. Leendertse

  6. Geriatric Department, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands

    R. J. van Marum

  7. Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands

    R. J. van Marum

Authors
  1. C. A. K. van der Stelt
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  2. A. M. A. Vermeulen Windsant-van den Tweel
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  3. A. C. G. Egberts
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  4. P. M. L. A. van den Bemt
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  5. A. J. Leendertse
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  6. W. A. J. J. Hermens
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  7. R. J. van Marum
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  8. H. J. Derijks
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Corresponding author

Correspondence to C. A. K. van der Stelt.

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Funding

No sources of funding were used to assist in the preparation of this study.

Conflict of interest

Cornelia van der Stelt, Annemieke Vermeulen Windsant-van den Tweel, Toine Egberts, Patricia van den Bemt, Anne Leendertse, Walter Hermens, Rob van Marum and Jeroen Derijks have no conflicts of interest that are directly relevant to the content of this study.

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van der Stelt, C.A.K., Vermeulen Windsant-van den Tweel, A.M.A., Egberts, A.C.G. et al. The Association Between Potentially Inappropriate Prescribing and Medication-Related Hospital Admissions in Older Patients: A Nested Case Control Study. Drug Saf 39, 79–87 (2016). https://doi.org/10.1007/s40264-015-0361-1

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