Prevalence of potentially inappropriate medication use by older patients in primary care

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About Prevalence of potentially inappropriate medication use by older patients in primary care

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Description

INTRODUCTION Older people often have more risk factors than younger adults that negatively influence the benefit/risk balance of medication use. Potentially inappropriate prescribing in older people is a well-documented problem and has been associated with adverse drug reactions and hospitalization. Therefore, it is essential for healthcare professionals to have tools to appropriately prescribe medication to older patients. For this purpose, The Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) and the Screening Tool to Alert doctors to Right Treatment (START) are screening tools that have been formulated to help physicians and pharmacists identify potentially inappropriate prescribing and potential prescribing omissions (Gallagher P et al., Int J Clin Pharmacol Ther. 2008 Feb;46(2):72-83.). In the Netherlands, the national guideline on polypharmacy in older patients has been established. An important part of the guideline consists of an implicit method for medication review. Within this method, the Dutch translation of the STOPP/START criteria is used as explicit method for drug optimisation. The guideline is meant to be used in primary care by general practitioners and community pharmacists, which will be obligatory within the near future with respect to older patients at risk of adverse events leading to falls and hospital admissions.


PROBLEM Potential errors of prescribing and of omission of medicines are prevalent among medically stable older people in primary care. In the Netherlands however, the prevalence of potentially inappropriate prescribing and potentially prescribing omissions in primary practice is, as far as we are aware of, not yet investigated. Since in the Netherlands the care system is different from other countries (e.g., the majority of Dutch patients go to one pharmacy), the prevalence might be different than in other countries. Recently, the STOPP/START criteria have been translated into ICD9, ICPC and ATC codes that facilitate computerised extraction from medical records and databases (De Groot et al. Age and Ageing 2014; 43: 773–778). As a result, potentially inappropriate prescribing and potentially prescribing omissions in primary practice can be evaluated with the use of primary care research databases, e.g. in the primary care research database of the family medicine departments of the AMC and the VUmc (HAG-net and ANH, respectively). If possible, other primary care research databases will be used as well.

RESEARCH QUESTIONS - What is the validity of the translated STOPP/START criteria? Explanation: Identification of potentially inappropriate medication (PIM) and omission of potentially beneficial medication (PBM) will be verified with general practitioners on a series of patients, in order to identify misclassifications (e.g., potentially beneficial medication that is not prescribed because of non-recorded contra-indications). - What is the prevalence of potentially inappropriate prescribing and potentially prescribing omissions in primary practice, in patients aged 65 years and older?

RESULTS This study will result in a master thesis as well as a publication in cooperation with VUmc. Steps to be taken, are a literature review of the prevalence of inappropriate prescribing in primary care; writing scripts for data extraction from both research databases; data extraction; and the use of statistical methods to estimate the prevalence of potentially inappropriate prescribing and potentially prescribing omissions.

Contact AMC

Dr. Erna Beers | coordinator HAGnet database | e.beers@amc.nl | 020-566 4175 Prof.dr. Ameen Abu-Hanna | Head of Medical Informatics department | a.abu-hanna@amc.uva.nl | 020-566 5959