Identification of inappropriate prescribing in geriatrics at a Veterans Affairs hospital using STOPP/START screening tools.
OBJECTIVE
Pharmacists' interventions of potentially inappropriate medications (PIM) decrease hospital admissions and emergency department visits and provide health-cost savings. The newest criterion to address PIMs is STOPP/START (Screening Tool of Older Person's Prescriptions/Screening Tool to Alert Doctor's to the Right Treatment). The purpose of this study is to determine the frequency of PIMs in a geriatric population.


METHODS
A retrospective chart review of 511 patients was conducted at a Veterans Affairs hospital in patients > 70 years of age.


METHODS
Charts were reviewed at hospital admission, discharge, and first follow-up clinic visit post-discharge for incidence of STOPP/START medications.


METHODS
STOPP/START criterion was applied to patients' medication lists and documented with omission or commission medications.


RESULTS
One hundred eleven (22%) patients met inclusion criteria. STOPP/START medication use was similar at all time points. Medications without an appropriate diagnosis were the most common type of STOPP criteria identified. Aspirin (> 150 mg daily) had high frequency of use. Incidence of START was highest with omissions of statin therapy, angiotensin-converting enzyme (ACE) inhibitor with heart failure, and vitamin D in patients with osteoporosis.


CONCLUSIONS
The results demonstrated that inappropriate prescribing and omission of medications occurs consistently at all points of care. STOPP/START criteria are more comprehensive than previous inappropriate prescribing lists. Utilization of a clinical pharmacist would benefit patients through elimination of PIMs and identification of medications to optimize patient care.
William S. Middleton Veterans Affairs (VA) Hospital, Madison, Wisconsin 53705, USA. pyszka@va.gov
Lauren L
LL
Pyszka
Trisha M
TM
Seys Ranola
Sara M
SM
Milhans
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D010343:Patient Admission / Q000592:standards; D010351:Patient Discharge / Q000592:standards; D010595:Pharmacists / Q000458:organization & administration*; D010607:Pharmacy Service, Hospital / Q000458:organization & administration; D010818:Practice Patterns, Physicians' / Q000592:standards*; D055553:Prescription Drugs / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D014481:United States
D055553:Prescription Drugs