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Potentially inappropriate medications in elderly Japanese patients: effects of pharmacists’ assessment and intervention based on Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions criteria ver.2
Author(s) -
Kimura T.,
Ogura F.,
Yamamoto K.,
Uda A.,
Nishioka T.,
Kume M.,
Makimoto H.,
Yano I.,
Hirai M.
Publication year - 2017
Publication title -
journal of clinical pharmacy and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.622
H-Index - 73
eISSN - 1365-2710
pISSN - 0269-4727
DOI - 10.1111/jcpt.12496
Subject(s) - medical prescription , medicine , intervention (counseling) , beers criteria , family medicine , intensive care medicine , psychiatry , nursing
Summary What is known and objectives The Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions ( stopp ) criteria were updated in 2014 ( stopp criteria ver.2), but few studies have evaluated the usefulness of stopp criteria in elderly patients. This prospective observational study evaluated the prevalence of potentially inappropriate medications ( PIM s), and the efficacy of hospital pharmacists’ assessment and intervention based on stopp criteria ver.2. Methods The study was conducted at three medical units of Kobe University Hospital between April 2015 and March 2016. Pharmacists assessed and detected PIM s based on stopp criteria ver.2 and considered the patient's intention to change the prescription at the time of admission of each patient. If the pharmacists judged that benefits outweighed risks of prescription change and the patients consented to change the medications, they recommended the doctor to change the prescription. If there was a risk of exacerbation of disease by the change of medications and the pharmacists judged it to be difficult to adjust medications during hospitalization or the patients did not consent to change the medications, they did not recommend to change it. The pharmacists and the doctors discussed and finally decided whether to change the PIM s or not. The number of patients prescribed PIM s, the number and contents of PIM s, and the number of medications changed after pharmacists’ intervention were calculated. Results Totally, 822 new inpatients aged ≥65 years prescribed ≥1 daily medicine were included. Their median (interquartile range) age was 75·0 (71·0–80·0) years, and 54·9% were male. According to the criteria, 346 patients (42·1%) were prescribed ≥1 PIM s. Patients prescribed PIM s took significantly more medications than others: 10·0 (7·0–13·0) vs. 6·0 (4·0–9·0), P < 0·001. The total number of PIM s was 651%, 47·6% of which ( n = 310) were recommended the doctors to change, and 292 of 651 PIM s (44·9%) were finally discontinued/changed after pharmacists’ assessment and intervention. PIM s related to benzodiazepines, including Z‐drugs, were most frequent, with a detailed classifications as follows (changed/total): (i) benzodiazepines for 4 or more weeks (75/205), (ii) drugs that predictably increase the risk of falls in older people (benzodiazepines) (30/67) and (iii) drugs that predictably increase the risk of falls in older people (hypnotic Z‐drugs) (15/31). Conclusion Over 40% elderly patients were prescribed PIM s, and pharmacists’ assessments and interventions based on stopp criteria ver.2 were useful in detecting and correcting prescription of PIM s.