Applicability of the STOPP/START criteria to older polypathological patients in a long-term care hospital

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Abstract
Objectives To analyse the applicability of the STOPP/START criteria as a tool to identify patients with potentially inappropriate medications (PIM) during pharmaceutical validation of prescriptions in a long-term care hospital, to identify risk factors for PIM and to characterise the physiological systems and drugs more frequently associated with these PIM. Methods An interventional, prospective and longitudinal study was conducted in polypathological patients aged >65 years. Usual pharmaceutical care and the STOPP/START criteria were used to identify PIM and to plan pharmaceutical interventions at admission. At discharge, the discharge summaries were reviewed using the STOPP/START criteria. Results 112 patients were included. The prevalence of patients with PIM at admission was 76.8%. The STOPP criteria identified a high number of PIM and almost all entailed pharmaceutical intervention. On the other hand, most of the START criteria identified did not entail pharmaceutical intervention. Usual pharmaceutical care detected a different type of PIM; a high percentage of pharmaceutical interventions to resolve them were accepted. At discharge, the prevalence of patients with PIM was 61.3%. At admission, none of the analysed variables was associated with the PIM identified using any of the tools. At discharge STOPP criteria identified a higher percentage of patients with PIM in the geriatric outpatient consultation group. Conclusions The prevalence of PIM in older polypathological patients is high. The STOPP criteria are useful for reducing inappropriate prescribing during the pharmaceutical validation process. In contrast, routine incorporation of the START criteria in the pharmaceutical validation may be not necessary in a hospital of this type.

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