Multidisciplinary medication review during older patient hospitalization according to STOPP/START criteria reduces potentially inappropriate prescriptions: MoPIM cohort study

Abstract

Purpose: 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.

Trial registration: NCT02830425.

Keywords: Clinical committee review; Multimorbidity; Older adults; Polypharmacy; Potentially inappropriate prescription; Prescription adequacy.

Fig. 1

Decisions taken at the clinical committee review process on PIM evolve during patients’ hospitalization. Sankey diagram representing the distribution of clinical decisions on the top 10 most frequent PIM detected at admission. Number and percentage of prescriptions withdrawn, modified or maintained (with or without justification) derived from the initial clinical decisions are shown in the second column, while final clinical decisions are depicted in the third column as amended or maintained. Colors associated to each STOPP criteria are indicated in the legend

Fig. 2

Decisions taken at the clinical committee review process on PPO evolve during patients’ hospitalization. Sankey diagram representing the distribution of clinical decisions on the top 10 most frequent PPO detected at admission. Number and percentage of prescriptions modified or maintained (with or without justification) derived from the initial clinical decisions are shown in the second column, while final clinical decisions are depicted in the third column as amended or maintained. In 18 START criteria the initial clinical decision was not registered. Colors associated to each START criteria are indicated in the legend