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Objective: The goal of this pharmacist-led study was to utilize two validated instruments, Beers Criteria and Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP), to assess potentially inappropriate prescribing (PIP) in older patients infected with the human immunodeficiency virus (HIV) and evaluate pharmacist interventions., Design: Prospective randomized interventional trial., Setting: Large urban clinic providing interdisciplinary primary and HIV care for ~2700 HIV-positive publicly insured patients., Data Source: A computerized electronic record search was conducted for all patients who met the two search criteria: 50 years and older, and a primary care appointment within the last 12 months., Patients: After identification of 857 patients meeting the search criteria, 324 patients were randomly selected and contacted, resulting in 248 patients assessed., Measurements and Main Results: Patients had a mean age of 58 years, 71% male, 44% white, and a mean CD4 count of 536 cells/mm 3 . Common comorbidities included hypertension (56%), depression (52%), asthma/chronic obstructive pulmonary disease (48%), dyslipidemia (39%), coronary artery disease (27%), and diabetes (22%). Patients sampled were prescribed a mean of 11.6 ± 5.7 concomitant medications (excluding antiretrovirals) with 35% receiving at least 16 medications. PIP was identified in 54% and 63% of patients using the STOPP and Beers Criteria, respectively. Twenty-five contraindicated drug interactions were identified in 20 patients. After the pharmacist visit, at least 69% of patients had at least one medication discontinued with almost 10% having six or more medications discontinued. More than 40% of patients had at least one Beers or STOPP criteria that required immediate correction by the pharmacist., Conclusions: Results suggest that targeting individuals with 11 or more chronic medications would have the highest yield and greatest impact. Pharmacist-led review of medication prescribing using Beers and STOPP criteria revealed a large number of PIP, many amenable to immediate clinical pharmacist intervention., (© 2017 Pharmacotherapy Publications, Inc.)

The demand for long-term care is expected to increase due to the rising life expectancy and the increased prevalence of long-term illnesses. Nursing home residents are at an increased risk of suffering adverse drug events due to inadequate prescriptions. The main objective of this systematic review is to collect and analyze the prevalence of potentially inadequate prescriptions based on the new version of STOPP/START criteria in this specific population. Databases (PubMed, Web of Science and Cochrane) were searched for inappropriate prescription use in nursing homes according to the second version of STOPP/START criteria. The risk of bias was assessed with the STROBE checklist. A total of 35 articles were assessed for eligibility. One hundred and forty nursing homes and more than 6900 residents were evaluated through the analysis of 13 studies of the last eight years. The reviewed literature returned prevalence ranges between 67.8% and 87.7% according to the STOPP criteria, according to START criteria prevalence ranged from 39.5% to 99.7%. The main factors associated with the presence of inappropriate prescriptions were age, comorbidities, and polypharmacy. These data highlight that, although the STOPP/START criteria were initially developed for community-dwelling older adults, its use in nursing homes may be a starting point to help detect more efficiently inappropriate prescriptions in institutionalized patients. We hope that this review will help to draw attention to the need for medication monitoring systems in this vulnerable population. [ABSTRACT FROM AUTHOR]

Background: Polypharmacy and inappropriate prescribing are risk factors for adverse drug reactions, which commonly cause complications in older people. The STOPP (Screening Tool of Older Persons' Prescriptions)/START (Screening Tool to Alert Doctors to Right Treatment) criteria are screening tools, which aim to improve prescribing in the elderly. Objectives: The aim was to improve prescribing, using the STOPP/START criteria, for patients aged 65 and above, who were admitted to the Clinical Decisions Unit at University Hospital Lewisham. We focused on the most common prescribing errors in clinical decision unit, an emergency medicine department. Methods: We reviewed all patients aged 65 and above admitted to the Clinical Decisions Unit in September. Data was collected from clinical documentation and archived drug charts. This pilot study of 114 patients revealed the most common prescribing errors, of which 8 were STOPP and 11 were START criteria. A plan–do–study–act methodology was implemented over 1 month, involving presentations, emails and posters. Prescribing patterns were then reviewed over 4 weeks in December in 111 patients. Results: Focusing on the 8 STOPP and 11 START criteria, there was a significant reduction in the proportion of patients with at least one STOPP error (17.5% to 9%, p = 0.04). However, the decrease in the percentage of patients with at least one START error was insignificant (24.6% to 20.7%, p = 0.24). Conclusion: By identifying problematic areas of prescribing and using targeted interventions, the proportion of STOPP errors made in clinical decision unit reduced significantly. This study highlights the prevalence of prescription errors in the clinical decision unit and the impact of using screening tools to reduce incorrect prescribing. [ABSTRACT FROM AUTHOR]

Zhuo Ma,1,* Caixia Zhang,1,2,* Xiangli Cui,1 Lihong Liu1 1Pharmacy Department of Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; 2Pharmacy Department of Civil Aviation General Hospital, Beijing, China *These authors contributed equally to this work Objectives: This study aimed to compare the prevalence of potentially inappropriate medications (PIMs) among Chinese aged patients using the Beers criteria of 2015, the Screening Tool of Older Persons’ Prescriptions (STOPP) of 2014 and the criteria of PIMs for older adults in China (Chinese criteria), and to identify the correlates of the PIMs’ use. Methods: A retrospective, cross-sectional study was conducted among geriatric patients at Beijing Chao-Yang Hospital between January 2018 and March 2018. Three criteria (the Beers criteria of 2015, the STOPP criteria of 2014 and the Chinese criteria) were used to detect PIMs. A multivariate logistic regression analysis was carried out to determine factors associated with the use of PIMs. Leading PIMs for each set of criteria were also listed. The concordance among the three PIM criteria was calculated using kappa tests. Results: Totally, 863 inpatients aged ≥65 years were included. The prevalence of patients receiving at least one PIM was 80.2%, 58.1% and 44.0% according to the Chinese criteria, 2015 Beers criteria and 2014 STOPP criteria, respectively. The Beers and the STOPP criteria indicated a moderate coherence, whereas the Chinese criteria showed poor concordance with the other two criteria. Proton-pump inhibitors in the Beers and STOPP criteria and clopidogrel in the PIM-Chinese accounted for most leading PIMs. The most important factor associated with PIM use by all three sets of criteria was the number of prescribed medications. Conclusion: Data showed a high PIM prevalence among older adults in China, which was associated with the number of prescribed medications. The Chinese criteria had the highest detection rate but a poor concordance with the Beers and STOPP criteria (P

Background Potentially inappropriate medications for older adults are those that offer more risks than benefits for this population. Such medications found in older adults' prescriptions across the world are associated with higher rates of comorbidities and hospitalizations, along with high expenditure on healthcare resources. Objectives To estimate the frequency of older adults using potentially inappropriate medications according to four different criteria, to identify factors associated with the use of such medicines and differences between the tools. Setting A primary healthcare unit linked to a university hospital in Porto Alegre, Brazil. Method This was a cross-sectional study conducted via data collection from the electronic medical records of 390 older adults. The information collected comprised sex, age, chronic diseases diagnosed and medications used. The dependent variable of the study was the use of at least one potentially inappropriate medication, according to the following criteria: Beers, Screening Tool of Older Persons' Prescriptions (STOPP), Brazilian consensus and Anticholinergic Risk Scale (ARS). Main outcome measurement Prevalence of inappropriate medication, differences between the tools and associated factors. Results: The use of at least one potentially inappropriate medication was found in 55.1% of the sample according to the Beers criterion, 51.3% according to the Brazilian consensus, 42.6% according to STOPP and 23.6% according to ARS. It was also seen that 14.9% of the studied population was exposed to a very strong anticholinergic risk. Depending on which tools were used, the agreement observed between the criteria was considered high, moderate, or low. Regarding the four criteria, the use of potentially inappropriate medication is associated with polypharmacy, the diagnosis of three or more chronic diseases and the presence of neuropsychiatric and musculoskeletal diseases. Conclusion Among the older adult population studied, the prevalence of potentially anappropriate medication is high, according to the four different classification criteria used. As a more specific tool, the agreement between Anticholinergic Risk Scale and other criteria was lower, but it can be an important complement to other lists. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Explicit criteria for evaluating the appropriateness of medication use among the elderly have been extensively employed in several countries. The aim of the current study was to assess and characterize the prevalence of potentially inappropriate medications ( PIMs) according to the Screening Tool of Older People's Prescriptions ( STOPP) criteria and compare these data with the 2012 Beers criteria. Methods A prospective survey of the medications used by elderly patients was performed. A total of 142 participants were randomly selected via systematic sampling. The Beers and STOPP criteria were applied to evaluate the use of PIMs among the sample. All of the medications included in these criteria were assessed for their availability in Brazil. The prevalence of PIMs was chosen as an occurrence measure and compared among the exposure group using the prevalence ratio ( PR) as a measure of association. Results The prevalence of PIM use in the sample was 33.8% according to the STOPP criteria and 51.8% using the 2012 Beers criteria. The most prevalent PIMs according to the Beers criteria were short-acting nifedipine (17.4%) and glyburide (11.9%); according to the STOPP criteria, they were acetylsalicylic acid (32.9%), clonazepam (10.1%) and diclofenac (6.3%). The use of four or more drugs (polypharmacy) was associated with a higher prevalence of PIM use ( PR = 3.11, 95% CIs = 1.65-5.85). Conclusions The 2012 Beers criteria identified more PIMs than the STOPP criteria. This difference highlights the need to develop national criteria. [ABSTRACT FROM AUTHOR]

Introduction: Elderly patients are a heterogeneous group who are prescribed a large number of medicaments. This leads to potentially inappropriate prescriptions. Objective: To analyze the pharmacotherapy of elderly patients from community pharmacy in order to detect potentially inappropriate Prescriptions (STOPP and Beers 2012) and potentially omitted prescriptions (START), determining its prevalence. Methodology: A descriptive, observational study in which patients over 65, who needed primary care and had at least one long-term treatment, were included. The appropriateness of the medicine was verified according to Beers 2012 and STOPP & START criteria. Results: 223 patients whose average age was 75 were included. 1558 medicines were prescribed in total, with an average of 7 medicaments per patient. 67 % of patients were polypharmacy. With Beers 2012, 246 inappropriate prescriptions were detected and the most repeated criteria were that of Benzodiazepines: short, intermediate and long (36 %) effect. With STOPP 146 inappropriate prescriptions were detected. The most common criterion was full-doze IBP for more than 8 weeks (14 %). With START, 103 potentially omitted prescriptions were detected, being antiplatelet in diabetes mellitus the most frequent (11.6 %). Conclusion: Beers and STOPP-START 2012 criteria represent a useful tool in the detection of potential drug-related problems in a community pharmacy. In no case they involve a ban on the use of these drugs, since its prescription depends on the characteristics of the individual patient and the clinical judgment of the prescribing physician. [ABSTRACT FROM AUTHOR]

Purpose: We sought to estimate the prevalence of potentially inappropriate prescribing (PIP) in the Northern Ireland (NI) population aged ≥70 years, to investigate factors associated with PIP and to calculate total gross cost of PIP. Methods: A retrospective cross-sectional population study was carried out in those aged ≥70 years in 2009/2010 who were in primary care in NI. Data were extracted from the Enhanced Prescribing Database, which provides details of prescribed and dispensed medications for each individual registered with a general practitioner. Twenty-eight PIP indicators from the Screening Tool of Older Persons potentially inappropriate Prescriptions (STOPP) criteria were applied to these data. PIP prevalence according to individual STOPP criteria and the overall prevalence of PIP were estimated. The relationship between PIP and polypharmacy, age and gender was examined using logistic regression. Gross cost of PIP was ascertained. Results: The overall prevalence of PIP in the study population ( n = 166,108) was 34 %. The most common examples of PIP identified were proton pump inhibitors at maximum therapeutic dose for >8 weeks (17,931 patients, 11 %), non-steroidal anti-inflammatory drugs >3 months (14,545 patients, 9 %) and long-term long-acting benzodiazepines (10,147 patients, 6 %). PIP was strongly associated with polypharmacy, with those receiving seven different medications being fivefold more likely to be exposed to PIP than those on zero to three medications (odds ratio 5.04, 95 % confidence interval 4.84-5.25) The gross cost of PIP was estimated to be €6,098,419 Conclusions: Consistent with other research, the prevalence of PIP was high among the study cohort, increased with polypharmacy and was associated with significant cost. [ABSTRACT FROM AUTHOR]