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A comparison of two tools to screen potentially inappropriate medication in internal medicine patients
Author(s) -
Blanc A.L.,
Spasojevic S.,
Leszek A.,
Théodoloz M.,
Bonnabry P.,
Fumeaux T.,
Schaad N.
Publication year - 2018
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.12638
Subject(s) - medicine , pharmacist , observational study , adverse effect , clinical pharmacy , emergency medicine , retrospective cohort study , population , pediatrics , pharmacy , family medicine , environmental health
Summary What is known Potentially inappropriate medication ( PIM ) is an important issue for inpatient management; it has been associated with safety problems, such as increases in adverse drugs events, and with longer hospital stays and higher healthcare costs. Objective To compare two PIM ‐screening tools— STOPP / START and PIM ‐Check—applied to internal medicine patients. A second objective was to compare the use of PIM s in readmitted and non‐readmitted patients. Method A retrospective observational study, in the general internal medicine ward of a Swiss non‐university hospital. We analysed a random sample of 50 patients, hospitalized in 2013, whose readmission within 30 days of discharge had been potentially preventable, and compared them to a sample of 50 sex‐ and age‐matched patients who were not readmitted. PIM s were screened using the STOPP / START tool, developed for geriatric patients, and the PIM ‐Check tool, developed for internal medicine patients. The time needed to perform each patient's analysis was measured. A clinical pharmacist counted and evaluated each PIM detected, based on its clinical relevance to the individual patient's case. The rates of screened and validated PIM s involving readmitted and non‐readmitted patients were compared. Results Across the whole population, PIM ‐Check and STOPP / START detected 1348 and 537 PIM s, respectively, representing 13.5 and 5.4 PIM s/patient. Screening time was substantially shorter with PIM ‐Check than with STOPP / START (4 vs 10 minutes, respectively). The clinical pharmacist judged that 45% and 42% of the PIM s detected using PIM ‐Check and STOPP / START , respectively, were clinically relevant to individual patients’ cases. No significant differences in the rates of detected and clinically relevant PIM were found between readmitted and non‐readmitted patients. What is new and conclusion Internal medicine patients are frequently prescribed PIM s. PIM ‐Check's PIM detection rate was three times higher than STOPP / START 's, and its screening time was shorter thanks to its electronic interface. Nearly half of the PIM s detected were judged to be non‐clinically relevant, however, potentially overalerting the prescriber. These tools can, nevertheless, be considered useful in daily practice. Furthermore, the relevance of any PIM detected by these tools should always be carefully evaluated within the clinical context surrounding the individual patient.