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Abstract：
OBJECTIVE: Multimorbidity and polypharmacy in older adults converts the detection and adequacy of potentially inappropriate drug prescriptions (PIDP) in a healthcare priority. The objectives of this study are to describe the clinical decisions taken after the identification of PIDP by clinical pharmacists, using STOPP/START criteria, and to evaluate the degree of accomplishment of these decisions.
METHODS: Multicenter, prospective, non-comparative cohort study in patients aged 65 and older, hospitalized because of an exacerbation of their chronic conditions. Each possible PIDP was manually identified by the clinical pharmacist at admission and an initial decision was taken by a multidisciplinary clinical committee. At discharge, criteria were re-applied and final decisions recorded.
RESULTS: From all patients (n = 674), 493 (73.1%) presented at least one STOPP criteria at admission, significantly reduced up to 258 (38.3%) at discharge. A similar trend was observed for START criteria (36.7% vs. 15.7%). Regarding the top 10 most prevalent STOPP criteria, the clinical committee initially agreed to withdraw 257 (34.2%) prescriptions and to modify 93 (12.4%) prescriptions. However, the evaluation of final clinical decisions revealed that 503 (67.0%) of those STOPP criteria were ultimately amended. For the top 10 START criteria associated PIDP, the committee decided to initiate 149 (51.7%) prescriptions, while a total of 198 (68.8%) were finally introduced at discharge.
CONCLUSIONS: The clinical committee, through a pharmacotherapy review, succeeded in identifying and reducing the degree of prescription inadequacy, for both STOPP and START criteria, in older patients with high degree of multimorbidity and polypharmacy.
BACKGROUND: NCT02830425.
METHODS: Multicenter, prospective, non-comparative cohort study in patients aged 65 and older, hospitalized because of an exacerbation of their chronic conditions. Each possible PIDP was manually identified by the clinical pharmacist at admission and an initial decision was taken by a multidisciplinary clinical committee. At discharge, criteria were re-applied and final decisions recorded.
RESULTS: From all patients (n = 674), 493 (73.1%) presented at least one STOPP criteria at admission, significantly reduced up to 258 (38.3%) at discharge. A similar trend was observed for START criteria (36.7% vs. 15.7%). Regarding the top 10 most prevalent STOPP criteria, the clinical committee initially agreed to withdraw 257 (34.2%) prescriptions and to modify 93 (12.4%) prescriptions. However, the evaluation of final clinical decisions revealed that 503 (67.0%) of those STOPP criteria were ultimately amended. For the top 10 START criteria associated PIDP, the committee decided to initiate 149 (51.7%) prescriptions, while a total of 198 (68.8%) were finally introduced at discharge.
CONCLUSIONS: The clinical committee, through a pharmacotherapy review, succeeded in identifying and reducing the degree of prescription inadequacy, for both STOPP and START criteria, in older patients with high degree of multimorbidity and polypharmacy.
BACKGROUND: NCT02830425.
摘要：
目的：老年人的多发病率和多药疗法将潜在不适当药物处方（PIDP）的检测和充分性转化为医疗保健优先事项。本研究的目的是描述临床药师鉴定PIDP后采取的临床决定，使用STOPP/START标准，并评估这些决定的完成程度。
方法：多中心，prospective,65岁及以上患者的非比较队列研究，因为他们的慢性病恶化而住院。每个可能的PIDP在入院时由临床药剂师手动鉴定，并由多学科临床委员会做出初步决定。出院时,重新应用标准并记录最终决定.
结果：来自所有患者（n=674），493（73.1%）在入院时提出了至少一个STOPP标准，出院时大幅减少至258人(38.3%)。START标准也观察到了类似的趋势(36.7%与15.7%）。关于十大最普遍的STOPP标准，临床委员会最初同意撤回257份(34.2%)处方,并修改93份(12.4%)处方.然而,对最终临床决策的评估显示,最终修订了STOPP标准中的503项(67.0%).对于与PIDP相关的前10个START标准，委员会决定启动149份(51.7%)处方，而最终共有198人(68.8%)在出院时被引入。
结论：临床委员会，通过药物治疗审查，成功地识别和减少了处方不足的程度，对于STOPP和START标准，在具有高度多发病率和多重用药的老年患者中。
背景：NCT02830425。
方法：多中心，prospective,65岁及以上患者的非比较队列研究，因为他们的慢性病恶化而住院。每个可能的PIDP在入院时由临床药剂师手动鉴定，并由多学科临床委员会做出初步决定。出院时,重新应用标准并记录最终决定.
结果：来自所有患者（n=674），493（73.1%）在入院时提出了至少一个STOPP标准，出院时大幅减少至258人(38.3%)。START标准也观察到了类似的趋势(36.7%与15.7%）。关于十大最普遍的STOPP标准，临床委员会最初同意撤回257份(34.2%)处方,并修改93份(12.4%)处方.然而,对最终临床决策的评估显示,最终修订了STOPP标准中的503项(67.0%).对于与PIDP相关的前10个START标准，委员会决定启动149份(51.7%)处方，而最终共有198人(68.8%)在出院时被引入。
结论：临床委员会，通过药物治疗审查，成功地识别和减少了处方不足的程度，对于STOPP和START标准，在具有高度多发病率和多重用药的老年患者中。
背景：NCT02830425。
