1
|
da Costa FA, Periquito C, Carneiro MC, Oliveira P, Fernandes AI, Cavaco-Silva P. Potentially inappropriate medications in a sample of Portuguese nursing home residents: Does the choice of screening tools matter? Int J Clin Pharm 2016; 38:1103-11. [PMID: 27343120 DOI: 10.1007/s11096-016-0337-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 06/15/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED Background Potentially inappropriate medications (PIMs) are often found in high proportion among the elderly population. The STOPP criteria have been suggested to detect more PIMs in European elderly than the Beers criteria. Objective This study aimed to determine the prevalence of PIMs and potential prescribing omissions (PPOs) in a sample of Portuguese nursing homes residents. Setting Four elderly facilities in mainland Portugal Method A descriptive cross-sectional study was used. Elderly polypharmacy patients were included in the study and their medication (registered in patient clinical records) analysed using the Beers (2012 original version and 2008 version adapted to Portugal), STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) criteria. Data were analysed using univariate and bivariate descriptive statistics, considering a confidence interval of 95 %. MAIN OUTCOME MEASURES Prevalence of PIMs and PPOs. Results The sample included 161 individuals, with a mean age of 84.7 years (SD = 6.35), 68.9 % being female. A total of 807 PIMs and 90 PPOs were identified through the application of the three set of criteria. The prevalence of PIMs using the most recent version of the Beers criteria was 85.1 and 42.1 % for independent and dependent of diagnosis, respectively. The Portuguese adaptation of this same tool indicated a lower prevalence of PIMs, 60.3 and 16.7 %, respectively. The prevalence of PIMs using the STOPP criteria was 75.4 %, whilst the prevalence of PPOs, using START, was 42.9 %. There were significant differences in the mean number of PIMs detected depending on the tool used. (p < 0.001). Conclusions The application of the studied criteria in an elderly sample enabled the identification of a notable amount of PIMs and PPOs, indicating there is room for improving the quality of care. The variation in prevalence indicates careful choice of the tool is a prerequisite for engaging in medication review. Using START/STOPP criteria enabled a more holistic approach to the quality of prescribing in the elderly, highlighting low levels of cardiovascular risk prevention and abuse of psychotropic drugs, aside with system failures largely preventable by electronic prescribing and alert generation.
Collapse
Affiliation(s)
- Filipa Alves da Costa
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-551, Caparica, Portugal. .,Epidemiology Department (ROR-Sul), Portuguese Institute of Oncology Lisbon Francisco Gentil (IPOLFG), Rua Prof. Lima Basto, 1099-023, Lisbon, Portugal. .,Pharmaceutical Society (OF), Rua da Sociedade Farmacêutica 18, 1169-075, Lisboa, Portugal.
| | - Catarina Periquito
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-551, Caparica, Portugal
| | - Maria Clara Carneiro
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-551, Caparica, Portugal
| | - Pedro Oliveira
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-551, Caparica, Portugal
| | - Ana Isabel Fernandes
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-551, Caparica, Portugal
| | - Patrícia Cavaco-Silva
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-551, Caparica, Portugal
| |
Collapse
|
2
|
Pereira Guerreiro M, Martins AP, Cantrill JA. Preventable drug-related morbidity in community pharmacy: commentary on the implications for practice and policy of a novel intervention. Int J Clin Pharm 2012; 34:682-5. [PMID: 22777317 DOI: 10.1007/s11096-012-9669-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 06/18/2012] [Indexed: 11/25/2022]
Abstract
This commentary relates to a paper on the development and piloting of a risk management intervention in Portuguese community pharmacy, based on validated preventable drug-related morbidity indicators. In the paper we presented the research programme and implications for future evaluation. However, we believe that the intervention may be seen as important for patient safety without further evaluation. Therefore in this commentary we discuss considerations for service roll-out, by revisiting some issues already presented and by introducing aspects such as service definition and remuneration. We argue that in the absence of service remuneration, redesign of care processes through IT support and inter-professional collaboration, and coaching to encourage the aforementioned efforts it is unlikely that the proposed risk management intervention will succeed in preventing drug-related morbidity.
Collapse
|