Inappropriate prescribing to older patients admitted to hospital: A comparison of different tools of misprescribing and underprescribing

Abstract

Inappropriate prescribing; Older multimorbidity patients; Potentially prescribing omissions

Prescripción inadecuada; Pacientes mayores con multimorbilidad; Omisiones potenciales en la prescripción

Prescripció inadequada; Pacients grans amb multimorbiditat; Omissions potencials en la prescripció

Purpose This study aims to assess inappropriate prescribing (IP) to elderly patients during the month prior to hospitalization and to compare different IP criteria. Methods An observational, prospective and multicentric study was carried out in the internal medicine services of seven Spanish hospitals. Patients aged 75 years and older were randomly selected after hospital admission for a year. To assess potentially inappropriate medicines (PIMs), the Beers and STOPP criteria were used and to assess potentially prescribing omissions (PPOs), the START criteria and ACOVE-3 medicine quality indicators were used. An analysis to assess factors associated with IP was performed. Results 672 patients [median age (Q1–Q3) 82 (79–86) years, 55.9% female] were included. Median prescribed medicines in the month prior to hospitalization were 10(Q1–Q3 7–13). The prevalence of IP was 87.6%, and 54.3% of patients had PIMs and PPOs concurrently. A higher prevalence rate of PIMs was predicted using the STOPP criteria than with the Beers criteria (p < 0.001) and a higher prevalence of PPOs using the ACOVE-3 criteria than using the START criteria (p < 0.001) was observed. Polypharmacy (≥ 10 medicines) was the strongest predictor of IP [OR = 11.34 95% confidence interval (CI) 4.96–25.94], PIMs [OR = 14.16, 95% CI 6.44–31.12], Beers-listed PIMs [OR = 8.19, 95% CI 3.01–22.28] and STOPP-listed PIMs [OR = 8.21, 95% CI 3.47–19.44]. PIMs was the strongest predictor of PPOs [OR = 2.79, 95% CI 1.81–4.28]. Conclusions A high prevalence of polypharmacy and PIMs and PPOs were reported. More than half the patients had simultaneous PIMs and PPOs. The related factors to PIMs and PPOs were different.

The project was financed by Grant No. EC10-211 obtained in a request for aid for the promotion of independent clinical research (SAS/ 2370/2010 Order of 27 September from the Spanish Ministry of Health, Social Affairs and Equality).