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Comparing Potentially Inappropriate Prescribing Tools and Their Association With Patient Outcomes
Author(s) -
Moriarty Frank,
Bennett Kathleen,
Kenny Rose Anne,
Fahey Tom,
Cahir Caitriona
Publication year - 2020
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.16239
Subject(s) - medicine , longitudinal study , geriatrics , beers criteria , medical prescription , emergency department , cohort study , confidence interval , pharmacy , gerontology , cohort , quality of life (healthcare) , prospective cohort study , family medicine , psychiatry , nursing , pathology
OBJECTIVE To assess the agreement of several different measures of potentially inappropriate prescribing (PIP) in older people and compare their relationship with patient‐reported outcomes. DESIGN Prospective cohort study including participants in The Irish Longitudinal Study on Ageing (TILDA). SETTING Waves 1 and 2 of TILDA, a nationally representative aging cohort study. PARTICIPANTS A total of 1753 community‐dwelling TILDA participants with linked administrative pharmacy claims data on medications. MEASUREMENTS Potentially inappropriate medications were assessed using the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) v1, American Geriatrics Society (AGS) Beers Criteria® 2012, and relevant Assessing Care of Vulnerable Elders (ACOVE) v3 indicators. Potential prescribing omissions were assessed using the Screening Tool to Alert Doctors to the Right Treatment (START) v1 and ACOVE v3 indicators. Their agreement was assessed via κ statistics, and multivariate regression was used to assess relationships with emergency department visits, general practitioner (GP) visits, quality of life, and functional decline (increased assistance needed for activities of daily living). RESULTS There was slight agreement between STOPP and AGS Beers Criteria® (κ = 0.20) and ACOVE indicators (κ = 0.15), while agreement between AGS Beers Criteria® and ACOVE indicators was fair (κ = 0.31). Agreement was fair between START and ACOVE indicators (κ = 0.34). All measures of inappropriate medications were significantly associated with increased GP visits. Only exposure to two or more START indicators was associated with reduced quality of life (adjusted mean difference = −1.12; 95% confidence interval [CI] = −1.92 to −0.33), and only two or more AGS Beers Criteria® were associated with functional decline (adjusted odds ratio = 2.11; 95% CI = 1.37‐3.28). For omissions, both measures were associated with functional decline, but only ACOVE indicators were associated with increased GP visits. CONCLUSION Prevalence of PIP and relationships with outcomes can differ substantially between tools with little agreement. Choice of PIP measure for research or practice should be considered in light of the circumstances and requirements in each case. J Am Geriatr Soc 68:526–534, 2020