Potentially inappropriate prescribing to older patients in primary care in the Netherlands: a retrospective longitudinal study.

Background: potentially inappropriate prescribing (PIP) is associated with adverse health effects in older patients. PIP comprises prescription of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). Objective: to estimate the prevalence of PIMs and PPOs among older patients in primary care. Design: retrospective longitudinal study. Setting: routinely collected data of 182,000 patients of 49 general practitioners (GPs) gathered in the GPs' database of the Academic Medical Center of Amsterdam, the Netherlands. Subjects: in each studied year, all patients who were aged 65 years and older at 1st January. Methods: the prevalence of patients with at least one PIM and patients with at least one PPO was measured in 8 subsequent years (2007-14) by application of the Screening Tool of Older Persons potentially inappropriate Prescriptions (STOPP)/Screening Tool to Alert doctors to Right Treatment (START) criteria. Multivariate logistic regression was used to evaluate trends in the prevalence of PIMs and PPOs over the years. Results: on average, 4,537 patients were included per investigated year. The mean prevalence of ≥1 PIM was 34.7% (range 34.0-35.6%) and of ≥1 PPO 84.8% (range 77.4-90.6%). Examples were the prescription of salicylates without a proper indication and the absence of a therapeutically indicated vitamin D prescription. The prevalence of ≥1 PPOs showed a statistically significant decrease over the investigated years (OR 0.87, P < 0.001), whereas the prevalence of PIMs did not change significantly. Conclusions: this study underscores the need for more attention to medication prescribing to older patients. The prevalence of PIP among older patients in primary care is substantial and the prevalence of PIMs did not decrease over time.

The Association Between the STOPP/START Criteria and Gastro-Intestinal Track Bleedings in Elderly Patients.

Potentially inappropriate prescribing is a common problem, especially in elderly care. To tackle this problem, Irish medical experts have developed a list of criteria when medication should be added or omitted based upon the patient's physical condition and medication use, known as the STOPP and START criteria. The STOPP and START criteria have been formulated to identify the prescribing of potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs). One of the most common problems of inappropriate prescribing is gastro-intestinal track bleedings. For this purpose, nine of the 87 STOPP and START criteria are designed to prevent this. However, the prevalence of gastro-intestinal track bleedings has not been established when these nine STOPP and START criteria are violated. The database contained 182,000 patients belonging to 49 general practitioners in the region of Amsterdam, The Netherlands. We estimated both the incidence of PIMs and PPOs and whether harm, in this case a gastro-intestinal track bleeding, occurred. We found that although violation of the nine STOPP or START criteria were possibly associated with harm (OR = 1.30), this association was not statistically significant (p = 0.323). Searching for evidence for harm informs decision support design aimed at improving quality of medication prescription as it prioritizes the many suggested criteria based on their relevance.