Prescripción potencialmente inadecuada en pacientes mayores grandes polimedicados según criterios «STOPP» / Potentially inappropriate prescription according to the "STOPP" Criteria in heavily polymedicated elderly patients

RESUMEN

Introducción. La adecuación en la prescripción terapéutica es especialmente relevante en pacientes mayores. El objetivo de este trabajo es analizar la prescripción potencialmente inadecuada (PPI) en pacientes ancianos grandes polimedicados según criterios del Screening Tool of Older Person's Prescriptions (STOPP). Pacientes y métodos. Estudio descriptivo transversal realizado en el centro de salud Siero-Sariego (Asturias), en el que participaron todos los pacientes mayores de 64 años adscritos al centro, grandes polimedicados (consumo ≥10 fármacos durante 6 meses). Se revisaron los 65 criterios del Screening Tool of Older Person's Prescriptions en la historia clínica electrónica de atención primaria. Se recogieron variables sociodemográficas, fármacos prescritos y patologías crónicas. Se calculó el índice de Charlson. Se realizaron distribuciones de frecuencias de cada criterio y se exploraron causas relacionadas con la PPI a través de tablas de contingencia, correlación de Spearman y regresión lineal. Resultados. Trescientos cuarenta y nueve grandes polimedicados (prevalencia 6,4 [IC 95% 5,76-7,08]), media 79 años (DE 3,7), 62,2% mujeres, 14% institucionalizados. Media de fármacos 11,5 (DE 1,7). Patologías más frecuentes hipertensión arterial (64%), diabetes (46%) y patología osteoarticular (41%). El 72,9% de los polimedicados tenía al menos una PPI. Media 1,32 (DE 1,2). Criterios del Screening Tool of Older Person's Prescriptions más incumplidos duplicidad terapéutica (25,2%), uso de benzodiacepinas de vida media larga (15,8%) y uso inadecuado de aspirina (10,9%). Se encontró asociación entre presentar alguna PPI y el número de fármacos dispensados (OR = 1,22 [IC 95% 1,04-1,43]) y de forma inversa al índice de Charlson (OR = 0,76 [IC 95% 0,65-0,89]). Conclusiones. La PPI es frecuente en grandes polimedicados. Debe prestarse especial atención al uso de fármacos psicotropos, implicados en un volumen importante de PPI (AU)

ABSTRACT

Introduction. Appropriate prescribing is especially relevant in elderly people. The objective of this study is to analyse the potentially inappropriate prescription (PIP) in heavily polymedicated elderly patients according to the criteria Screening Tool of Older Person's Prescriptions. Patients and methods. A descriptive cross-sectional study was conducted in Primary Care on patients assigned to the Siero-Sariego (Asturias) Health Centre, who were over 64 years old and heavily polymedicated (consumption >10 drugs for six months). The 65 Screening Tool of Older Person's Prescriptions criteria were reviewed in the electronic Primary Care patient records, collecting sociodemographic variables, prescribed medications, and chronic diseases. Frequency distributions were made for each criterion, and causes related to PIP were explored using contingency tables, the Spearman correlation coefficient, and logistic regression. Results. A total of 349 polymedicated elderly patients were analysed with a prevalence of 6.4 (95% CI 5.76-7.08), a mean age of 79.2 years (SD 3.7), 62.2% were female, 14% institutionalised, a Charlson index of 2.9. The mean of number of drugs was 11.5 (SD 1.7), and the most frequent pathologies were high blood pressure (64%), diabetes (46%), and osteoarticular diseases (41%). There was at least one PIP in 72.9% of heavily polymedicated elderly patients [(Mean 1.32 (SD 1.2)]. The Screening Tool of Older Person's Prescriptions criteria least complied with were therapeutic duplication (25.2%), use of long-acting benzodiazepines (15.8%), and inappropriate use of aspirin (10.9%). An association was found between having any inappropriate prescription and the number of medications prescribed (OR = 1.22 [95% CI 1.04-1.43]) and inversely to the Charlson index (OR = 0.76 [95% CI 0.65-0.89]). Conclusions. PIP is common in heavily polymedicated elderly patients. Special attention must be paid to the use of psychotropic drugs, which are implicated in a high volume of PIP (AU)