Prevalence and factors associated with potentially inappropriate prescriptions among older patients at hospital discharge.

RATIONALE, AIMS AND OBJECTIVES: Explicit criteria have been used worldwide to identify suboptimal prescribing such as potentially inappropriate prescriptions (PIPs). The objective of our study was to determine prevalence, types and factors associated with PIPs in older people discharged from an Albanian hospital. METHOD: Retrospective, cross-sectional study conducted among patients aged 60 years and more discharged from the Cardiology and Internal Medicine departments of the University Hospital Center 'Mother Theresa' Tirana during 2013. PIPs were identified by using Beers (2012 update) and STOPP criteria (2008 and 2014 versions). Chi-square analysis and Student Test were performed. Crude and adjusted odds ratios with their 95% confidence intervals were estimated by logistic regression analysis. RESULTS: Medical files for 319 patients were assessed. The median number of drugs prescribed was 7.8 (SD 2.2). PIPs prevalence at hospital discharge was 34.5% (95% CI 27.5-42.2%; 110 patients) according to both Beers and STOPP version 1 criteria. STOPP version 2 identified 201 (63.0%) patients with at least one PIP (95% CI 55.2-70.2%; 312 PIPs). The drugs more frequently involved in PIPs were aspirin, spironolactone, benzodiazepines, digoxin and methyldopa. The odds of having a PIP were higher in patients discharged from Internal Medicine (P < 0.005). The PIP index was 0.056%, 0.054% and 0.125% respectively for Beers, STOPP 2008 and STOPP 2014 criteria. A significant positive correlation was found between the number of prescribed drugs and PIP occurrence. CONCLUSIONS: Our study found that between one and two out of three older patients has at least one PIP among the treatment prescribed at hospital discharge, depending on the tool used for detection. The high frequency of PIPs suggests the urgent need for interventions to reduce them.

Polypharmacy and potentially inappropriate prescriptions identified by Beers and STOPP criteria in co-morbid older patients at hospital discharge.

RATIONALE, AIMS AND OBJECTIVES: The objective of this study was to evaluate the prevalence of potentially inappropriate prescriptions (PIP) and the association with polypharmacy (more than six drugs prescribed) in co-morbid older patients in a critical moment of care transition such as hospital discharge by means of two explicit criteria (Beers 2012 and STOPP 2008). METHOD: Cross-sectional study carried out in an older patients' population (≥65 years old) discharged from a university hospital in Spain. We recorded patients' information regarding demographics, diagnosis, drugs prescribed and associated pathological conditions and calculated the Charlson co-morbidity index. Data were obtained from the electronic medical records of hospital discharge. Beers (2012) and STOPP criteria (2008) were applied for PIP detection. The strength of association between polypharmacy and the presence of PIP was assessed by calculating the crude and adjusted odds ratio and its 95% confidence interval. RESULTS: From 1004 patients of a 15% random sample, just 624 that fulfilled the inclusion criteria were included in the study. The number of prescribed drugs was a risk factor for PIP according to both criteria, even after adjusting for confounding variables. PIP frequency was higher in patients who received more than 12 medications (Beers: 34.8%, STOPP: 54.4%). Each additional medication increased the risk of PIP by 14 or 15% (Beers or STOPP). CONCLUSIONS: Our results suggest that the strategies used for PIP reduction in co-morbid older patients should focus on the management of polypharmacy. Medication review at hospital discharge is highly recommended for patients taking more than six drugs.

Prevalence and Correlates of Drug-drug Interactions in the Regional Hospital of Gjilan, Kosovo.

AIM: Our aim was to assess the prevalence and socioeconomic and clinical correlates of drug-drug interactions among the adult population of transitional Kosovo. METHODS: A cross-sectional study was conducted including a representative sample of 1921 patients aged ≥18 years (mean age: 57.8±11.2 years; 50.3% women; overall response: 96%) from the regional hospital of Gjilan, Kosovo, during 2011-2013. Potential drug-drug-interactions were assessed and clinical data as well as demographic and socioeconomic information were collected. Binary logistic regression was used to assess the correlates of drug-drug interactions. RESULTS: Upon multivariable adjustment for all the demographic and socioeconomic factors as well as the clinical characteristics, drug-drug interactions were positively and significantly related to older age (OR=2.1, 95%CI=1.3-2.8), a lower educational attainment (OR=1.4, 95%CI=1.1-1.9), a longer hospitalization period (OR=2.7, 95%CI=2.1-3.6), presence of three groups of diseases [infectious diseases (OR=1.7, 95%CI=1.3-2.4), cardiovascular diseases (OR=1.8, 95%CI=1.4-2.6), respiratory diseases (OR=1.6, 95%CI=1.2-2.5)], presence of comorbid conditions (OR=3.2, 95%CI=2.3-4.4) and an intake of at least four drugs (OR=5.9, 95%CI=4.6-7.1). CONCLUSIONS: Our study provides important evidence on the prevalence and socioeconomic and clinical correlates of drug-drug interactions among the hospitalized patients in the regional hospital of Gjilan, Kosovo. Findings from our study should raise the awareness of decision-makers and policy makers about the prevalence and determinants of drug-drug interactions in the adult population of post-war Kosovo.

Frequency of potentially inappropriate prescriptions in older people at discharge according to Beers and STOPP criteria.

BACKGROUND: Potentially inappropriate prescriptions (PIP) are frequent, generate negative outcomes, and are to a great extent avoidable. Although there is general agreement about the definition of PIP, how to measure them is a matter of debate. OBJECTIVE: Our aim was to measure the frequency of PIP in older people at hospital discharge using two sets of criteria--Beers (2012 update) and STOPP. SETTING: A university hospital in southern Spain. METHOD: This cross sectional study involved a random sample of patients 65 years or more discharged from the University Hospital San Cecilio (Granada, Spain), from July 1, 2011 to June 30, 2012. Age, gender, length of hospital stay, type of hospital service, drugs prescribed and pathologies were obtained from discharge reports. MAIN OUTCOME MEASURE: The main outcome measures were: (1) the prevalence of PIP according to each set of criteria (Beers and STOPP) and its 95 % confidence interval, globally and stratified for different categories of the study variables; (2) the degree of agreement between the two criteria using Kappa statistics; and (3) the drugs most commonly involved in PIP according to both criteria. RESULTS: There were 624 patients (median age 78) included in our study. According to Beers criteria, 22.9 % (19.6-26.2 %) of the patients had at least one PIP. This figure was 38.4 % (34.6-42.2 %) for STOPP criteria. Just 13.6 % of the patients had prescriptions simultaneously inappropriate for both criteria. Higher PIP frequency was observed in patients discharged from internal medicine. PIP increased with the Charlson Index and with the number of drugs prescribed, but not with gender, age or length of hospital stay. CONCLUSION: A very high frequency of PIP at discharge was observed. By intervening in five drug groups, about 80 % of PIP might be avoided according to either of the two criteria.