Potentially inappropriate prescribing and prescribing omissions affect 60% of the elderly

The Research Group in Therapeutics in Primary Care (GRETAP) of the IDIAP Jordi Gol has analysed potentially inappropriate prescription (PIP) in the elderly according to the criteria STOPP/START, a tool to detect possible treatment errors and prescribing omission in the elderly. The STARTREC study shows that almost 60% of patients over 70 years of age have at least one prescribed drug potentially inappropriate and/or miss the prescription of at least one potentially indicated medication, according to the criteria STOPP/START.

Potentially inappropriate prescription occurs when the risk of adverse effects is higher than the clinical benefit, when the dose or duration exceeds recommendations, when there is a high risk of interaction with other drugs or due to the condition of the patient and/or there is more than one drug of the same class prescribed; similarly, the omission to prescribe medication that could be of benefit is considered inadequate.

The STARTREC study has been conducted in the primary care setting of the Lleida Health Region and includes a sample of 45,408 patients 70 years of age and over visited by any primary health care professional.

The results show that 58.1% patients fail to meet at least one STOPP and one START criteria. Moreover, PIP increases with age and with the number of drugs prescribed, and is more common amongst patients living in care homes and patients seen in their own homes.

The most common PIP is the use of antiplatelet agents for primary prevention in patients with no cardiovascular disease (14.8%); prescribing omission occurs mainly when antithrombotic agents and statins are not prescribed in patients with diabetes and cardiovascular risk (17.72% and 10.41%, respectively). With regard to indication, the analyses of the criteria STOPP/START show that the prescription of benzodiazepines is longer than recommended by guidelines in over 70% of patients; and the most common START criteria is the lack of bisphosphonates in patients treated with oral steroids (80.9%)

Reference:
Cruz-Esteve I, et al. Análisis poblacional de la prescripción potencialmente inadecuada en ancianos según criterios STOPP/START (estudio ESTARTREC), Aten Primaria 2016. http://dx.doi.org/10.1016/j.aprim.2016.02.013