[Adequacy of the pharmacological prescription during the admission in a geriatric hospital. Clinical experiencie with STOPP/START criteria]. / Adecuación de la prescripción farmacológica durante el ingreso en un centro sociosanitario: experiencia clínica con los criterios STOPP/START.

BACKGROUND AND OBJECTIVES: The elderly patient is particularly vulnerable to potentially inappropriate prescription (PIP) due to physiological reasons, comorbidity, polypharmacy or the different pharmacokinetics/pharmacodynamics of drugs. The aim of this study was to determine the prevalence of PIP according to the STOPP-START criteria in patients over 65 years admitted into a geriatric hospital, as well as to appraise its acceptance by geriatricians. MATERIAL AND METHODS: Retrospective observational study. Patients older than 65 years consecutively admitted to medium/long-stay units were included. The study information was obtained by reviewing the clinical record of the patients. The PIP according to the STOPP-START criteria were assessed by the geriatrician, who decided whether or not to modify the medication and recorded the reasons. RESULTS: 247 patients were included, mean age was 82.6 years (SD 7.3), 72.1% of patients were female and a median of 7 drugs (25-75 percentile: 4-9). 78.9% (95%CI: 73.3-83.9) of patients had at least one PIP STOPP-START at admission, 44.9% (95%CI: 38.6-51.4) PIP-STOPP and 59.5% (95%CI: 53.1-65.7) PIP-START. At hospital discharge, the prevalence of PIP-STOPP-START was 46.2% (95%CI: 39.8-52.6), 19.0% (95%CI: 14.3-24.5) of PIP-STOPP and 34.4% (95%CI: 28.5-40.7) PIP-START. CONCLUSIONS: The comprehensive geriatric assessment and the use of the STOPP-START criteria can significantly reduce the prevalence of PIP among patients admitted to a geriatric hospital. Nevertheless, issues such as frailty, multimorbidity and functional goals would be taken into account in the appropriateness of the prescription.

Evaluation of pharmacotherapy used on geriatric population in an institution of special regime with the screening tool of older persons' potentially inappropriate prescriptions (STOPP) criteria / Evaluación de la farmacoterapia en población geriátrica de una institución de régimen especial con los criterios the screening tool of older persons' potentially inappropriate prescriptions (STOPP)

Background: Geriatric patients represent a major challenge for appropriate prescription because they have significant changes in vital areas, multiple comorbidities among other things that encourage their fragility. In light of current evidence, the number of prescription errors increases with age and with the number of drugs USED, showing that people over 65 is at greater risk of medical error when more than 8 drugs are consumed. Objectives: To identify and describe the inappropriate medicines in elderly people in order to propose an institutional prescription guide based on the results of the application of the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) assessment methodology. Methods: A cross-section observational study with a retrospective collection of information was carried out in order to identify the frequency of inappropriate prescriptions in 300 elderly patients that were over 65 years, with a consumption of more than 5 medications and applying the STOPP criteria. The study was made in a special regime medical institution, reviewing medical records and considering variables such as number of medications, indications, dosage, therapeutic duplication, interactions and contraindications, among others. Results: The principal diagnosis was hipertension (47%) followed by diabetes mellitus (10%) and other hypothyroidisms (4%).After applying the STOPP criteria to each of the medical records, it was found that 50.7% (152) of the studied population had at least one inappropriate prescription distributed as follows: 2 prescriptions had 4 STOPP criteria, 7 prescriptions had 3 STOPP criteria, 28 had 2 STOPP criteria and 115 had 1 STOPP criteria. Conclusions: It was found that half of the prescriptions have at least one inadequate prescribed criteria, being the most important the inappropriate use of not indicated drugs or without an indication. Finally, guidelines for the rational use of drugs in the elderly with every detail of this institution are proposed.

Antecedentes: Los pacientes geriátricos representan un reto importante para la prescripción apropiada porque tienen cambios significativos en sus funciones vitales y múltiples comorbilidades, entre otros, que los hacen frágiles. A la luz de la evidencia actual, el número de errores de prescripción aumenta con la edad y con el número de fármacos, demostrando que las personas mayores de 65 años tienen mayor riesgo de sufrir un error médico cuando se consumen más de 8 medicamentos. Objetivos: Identificar y describir los medicamentos inapropiados en adultos mayores con el fin de proponer una guía de prescripción institucional basada en los resultados de la aplicación de los criterios de evaluación de prescripción potencialmente inapropiados en adultos mayores (STOPP). Métodos: Se llevó a cabo un estudio observacional descriptivo de corte transversal, con recolección retrospectiva de información. Se cuantificó la frecuencia de prescripciones inadecuadas en 300 pacientes mayores de 65 años y con un consumo de más de 5 medicamentos. Posterior a esto se aplicaron los criterios STOPP por revisión de historias clínicas en una institución de régimen especial teniendo en cuenta variables como el número de medicamentos, indicación, posología, duplicidad terapéutica, interacciones, contraindicaciones, entre otros. Los criterios STOPP de prescripciones potencialmente inadecuadas contemplan el análisis por sistemas fisiológicos buscando posibles interacciones medicamentosas, contraindicaciones, duplicidad terapéutica y medicamentos que puedan representar un riesgo en adultos mayores por presentar cambios en su farmacocinética. Resultados: El diagnóstico principal es la presión arterial alta (47%), seguida de la diabetes mellitus (10%) y otros hipotiroidismos (4%). Después de aplicar los criterios STOPP para cada una de las historias clínicas, se encontró que el 50,7% (152) de la población del estudio tenía al menos una prescripción inadecuada distribuida de la siguiente manera: 2 recetas tenían 4 criterios STOPP, 7 recetas tenían 3 criterios STOPP, 28 tenían dos criterios STOPP y 115 tenían 1 criterios STOPP. Conclusiones: Se encontró que la mitad de las recetas tienen al menos un criterio de prescripción inadecuado, siendo el más importante el uso inadecuado de los medicamentos no indicados o sin indicación aparente. Por último, se proponen directrices para el uso racional de los medicamentos en los ancianos con todos los detalles de esta institución.