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Potentially inappropriate medications in elderly Japanese patients: effects of pharmacists' assessment and intervention based on Screening Tool of Older Persons' Potentially Inappropriate Prescriptions criteria ver.2.
J Clin Pharm Ther. 2017 Apr; 42(2):209-214.JC

Abstract

WHAT IS KNOWN AND OBJECTIVES

The Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (stopp) criteria were updated in 2014 (stopp criteria ver.2), but few studies have evaluated the usefulness of stopp criteria in elderly patients. This prospective observational study evaluated the prevalence of potentially inappropriate medications (PIMs), and the efficacy of hospital pharmacists' assessment and intervention based on stopp criteria ver.2.

METHODS

The study was conducted at three medical units of Kobe University Hospital between April 2015 and March 2016. Pharmacists assessed and detected PIMs based on stopp criteria ver.2 and considered the patient's intention to change the prescription at the time of admission of each patient. If the pharmacists judged that benefits outweighed risks of prescription change and the patients consented to change the medications, they recommended the doctor to change the prescription. If there was a risk of exacerbation of disease by the change of medications and the pharmacists judged it to be difficult to adjust medications during hospitalization or the patients did not consent to change the medications, they did not recommend to change it. The pharmacists and the doctors discussed and finally decided whether to change the PIMs or not. The number of patients prescribed PIMs, the number and contents of PIMs, and the number of medications changed after pharmacists' intervention were calculated.

RESULTS

Totally, 822 new inpatients aged ≥65 years prescribed ≥1 daily medicine were included. Their median (interquartile range) age was 75·0 (71·0-80·0) years, and 54·9% were male. According to the criteria, 346 patients (42·1%) were prescribed ≥1 PIMs. Patients prescribed PIMs took significantly more medications than others: 10·0 (7·0-13·0) vs. 6·0 (4·0-9·0), P < 0·001. The total number of PIMs was 651%, 47·6% of which (n = 310) were recommended the doctors to change, and 292 of 651 PIMs (44·9%) were finally discontinued/changed after pharmacists' assessment and intervention. PIMs related to benzodiazepines, including Z-drugs, were most frequent, with a detailed classifications as follows (changed/total): (i) benzodiazepines for 4 or more weeks (75/205), (ii) drugs that predictably increase the risk of falls in older people (benzodiazepines) (30/67) and (iii) drugs that predictably increase the risk of falls in older people (hypnotic Z-drugs) (15/31).

CONCLUSION

Over 40% elderly patients were prescribed PIMs, and pharmacists' assessments and interventions based on stopp criteria ver.2 were useful in detecting and correcting prescription of PIMs.

Authors+Show Affiliations

Department of Pharmacy, Kobe University Hospital, Kobe, Japan.Department of Pharmacy, Kobe University Hospital, Kobe, Japan.Department of Pharmacy, Kobe University Hospital, Kobe, Japan.Department of Pharmacy, Kobe University Hospital, Kobe, Japan.Department of Pharmacy, Kobe University Hospital, Kobe, Japan.Department of Pharmacy, Kobe University Hospital, Kobe, Japan.Department of Pharmacy, Kobe University Hospital, Kobe, Japan.Department of Pharmacy, Kobe University Hospital, Kobe, Japan.Department of Pharmacy, Kobe University Hospital, Kobe, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28039932

Citation

Kimura, T, et al. "Potentially Inappropriate Medications in Elderly Japanese Patients: Effects of Pharmacists' Assessment and Intervention Based On Screening Tool of Older Persons' Potentially Inappropriate Prescriptions Criteria Ver.2." Journal of Clinical Pharmacy and Therapeutics, vol. 42, no. 2, 2017, pp. 209-214.
Kimura T, Ogura F, Yamamoto K, et al. Potentially inappropriate medications in elderly Japanese patients: effects of pharmacists' assessment and intervention based on Screening Tool of Older Persons' Potentially Inappropriate Prescriptions criteria ver.2. J Clin Pharm Ther. 2017;42(2):209-214.
Kimura, T., Ogura, F., Yamamoto, K., Uda, A., Nishioka, T., Kume, M., Makimoto, H., Yano, I., & Hirai, M. (2017). Potentially inappropriate medications in elderly Japanese patients: effects of pharmacists' assessment and intervention based on Screening Tool of Older Persons' Potentially Inappropriate Prescriptions criteria ver.2. Journal of Clinical Pharmacy and Therapeutics, 42(2), 209-214. https://doi.org/10.1111/jcpt.12496
Kimura T, et al. Potentially Inappropriate Medications in Elderly Japanese Patients: Effects of Pharmacists' Assessment and Intervention Based On Screening Tool of Older Persons' Potentially Inappropriate Prescriptions Criteria Ver.2. J Clin Pharm Ther. 2017;42(2):209-214. PubMed PMID: 28039932.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Potentially inappropriate medications in elderly Japanese patients: effects of pharmacists' assessment and intervention based on Screening Tool of Older Persons' Potentially Inappropriate Prescriptions criteria ver.2. AU - Kimura,T, AU - Ogura,F, AU - Yamamoto,K, AU - Uda,A, AU - Nishioka,T, AU - Kume,M, AU - Makimoto,H, AU - Yano,I, AU - Hirai,M, Y1 - 2016/12/31/ PY - 2016/11/04/received PY - 2016/11/29/accepted PY - 2017/1/1/pubmed PY - 2017/8/2/medline PY - 2017/1/1/entrez KW - elderly KW - inappropriate prescribing KW - polypharmacy KW - potentially inappropriate medications KW - stopp criteria ver.2 SP - 209 EP - 214 JF - Journal of clinical pharmacy and therapeutics JO - J Clin Pharm Ther VL - 42 IS - 2 N2 - WHAT IS KNOWN AND OBJECTIVES: The Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (stopp) criteria were updated in 2014 (stopp criteria ver.2), but few studies have evaluated the usefulness of stopp criteria in elderly patients. This prospective observational study evaluated the prevalence of potentially inappropriate medications (PIMs), and the efficacy of hospital pharmacists' assessment and intervention based on stopp criteria ver.2. METHODS: The study was conducted at three medical units of Kobe University Hospital between April 2015 and March 2016. Pharmacists assessed and detected PIMs based on stopp criteria ver.2 and considered the patient's intention to change the prescription at the time of admission of each patient. If the pharmacists judged that benefits outweighed risks of prescription change and the patients consented to change the medications, they recommended the doctor to change the prescription. If there was a risk of exacerbation of disease by the change of medications and the pharmacists judged it to be difficult to adjust medications during hospitalization or the patients did not consent to change the medications, they did not recommend to change it. The pharmacists and the doctors discussed and finally decided whether to change the PIMs or not. The number of patients prescribed PIMs, the number and contents of PIMs, and the number of medications changed after pharmacists' intervention were calculated. RESULTS: Totally, 822 new inpatients aged ≥65 years prescribed ≥1 daily medicine were included. Their median (interquartile range) age was 75·0 (71·0-80·0) years, and 54·9% were male. According to the criteria, 346 patients (42·1%) were prescribed ≥1 PIMs. Patients prescribed PIMs took significantly more medications than others: 10·0 (7·0-13·0) vs. 6·0 (4·0-9·0), P < 0·001. The total number of PIMs was 651%, 47·6% of which (n = 310) were recommended the doctors to change, and 292 of 651 PIMs (44·9%) were finally discontinued/changed after pharmacists' assessment and intervention. PIMs related to benzodiazepines, including Z-drugs, were most frequent, with a detailed classifications as follows (changed/total): (i) benzodiazepines for 4 or more weeks (75/205), (ii) drugs that predictably increase the risk of falls in older people (benzodiazepines) (30/67) and (iii) drugs that predictably increase the risk of falls in older people (hypnotic Z-drugs) (15/31). CONCLUSION: Over 40% elderly patients were prescribed PIMs, and pharmacists' assessments and interventions based on stopp criteria ver.2 were useful in detecting and correcting prescription of PIMs. SN - 1365-2710 UR - https://www.unboundmedicine.com/medline/citation/28039932/Potentially_inappropriate_medications_in_elderly_Japanese_patients:_effects_of_pharmacists'_assessment_and_intervention_based_on_Screening_Tool_of_Older_Persons'_Potentially_Inappropriate_Prescriptions_criteria_ver_2_ L2 - https://doi.org/10.1111/jcpt.12496 DB - PRIME DP - Unbound Medicine ER -