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The Association Between Potentially Inappropriate Prescribing and Medication-Related Hospital Admissions in Older Patients: A Nested Case Control Study.
Drug Saf. 2016 Jan; 39(1):79-87.DS

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.

Authors+Show Affiliations

Department of Clinical Pharmacy, ZANOB, Jeroen Bosch Hospital, PO Box 3406, 5203 DK, 's-Hertogenbosch, The Netherlands. r.v.d.stelt@zanob.nl.Department of Clinical Pharmacy, ZANOB, Jeroen Bosch Hospital, PO Box 3406, 5203 DK, 's-Hertogenbosch, The Netherlands.Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands. Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands.Department of Clinical Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands.Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands.Department of Clinical Pharmacy, ZANOB, Jeroen Bosch Hospital, PO Box 3406, 5203 DK, 's-Hertogenbosch, The Netherlands.Geriatric Department, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands. Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.Department of Clinical Pharmacy, ZANOB, Jeroen Bosch Hospital, PO Box 3406, 5203 DK, 's-Hertogenbosch, The Netherlands. Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26553305

Citation

van der Stelt, C A K., et al. "The Association Between Potentially Inappropriate Prescribing and Medication-Related Hospital Admissions in Older Patients: a Nested Case Control Study." Drug Safety, vol. 39, no. 1, 2016, pp. 79-87.
van der Stelt CA, Vermeulen Windsant-van den Tweel AM, Egberts AC, et al. The Association Between Potentially Inappropriate Prescribing and Medication-Related Hospital Admissions in Older Patients: A Nested Case Control Study. Drug Saf. 2016;39(1):79-87.
van der Stelt, C. A., Vermeulen Windsant-van den Tweel, A. M., Egberts, A. C., van den Bemt, P. M., Leendertse, A. J., Hermens, W. A., van Marum, R. J., & Derijks, H. J. (2016). The Association Between Potentially Inappropriate Prescribing and Medication-Related Hospital Admissions in Older Patients: A Nested Case Control Study. Drug Safety, 39(1), 79-87. https://doi.org/10.1007/s40264-015-0361-1
van der Stelt CA, et al. The Association Between Potentially Inappropriate Prescribing and Medication-Related Hospital Admissions in Older Patients: a Nested Case Control Study. Drug Saf. 2016;39(1):79-87. PubMed PMID: 26553305.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Association Between Potentially Inappropriate Prescribing and Medication-Related Hospital Admissions in Older Patients: A Nested Case Control Study. AU - van der Stelt,C A K, AU - Vermeulen Windsant-van den Tweel,A M A, AU - Egberts,A C G, AU - van den Bemt,P M L A, AU - Leendertse,A J, AU - Hermens,W A J J, AU - van Marum,R J, AU - Derijks,H J, PY - 2015/11/11/entrez PY - 2015/11/11/pubmed PY - 2016/11/1/medline SP - 79 EP - 87 JF - Drug safety JO - Drug Saf VL - 39 IS - 1 N2 - 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. SN - 1179-1942 UR - https://www.unboundmedicine.com/medline/citation/26553305/The_Association_Between_Potentially_Inappropriate_Prescribing_and_Medication_Related_Hospital_Admissions_in_Older_Patients:_A_Nested_Case_Control_Study_ L2 - https://dx.doi.org/10.1007/s40264-015-0361-1 DB - PRIME DP - Unbound Medicine ER -