Inappropriate prescribing according to the STOPP/START criteria in older people from a primary care setting.
BACKGROUND
STOPP (screening tool of older persons' prescriptions)/START (screening tool to alert doctors to right treatment) criteria aim to identify potentially inappropriate medication (PIM) due to mis-, over- and under-prescription in older patients. Initially developed by Irish experts, their applicability has been demonstrated in primary health care (PHC).


OBJECTIVE
To quantify and identify the most frequent PIM at PHC level using STOPP/START criteria. To identify factors that may modulate the onset of PIM.


METHODS
Audit of a random sample of 272 electronic health records (including prescription, diagnosis and laboratory results) of patients ≥ 65 years old, with at least one prescription in the last three months, from a PHC setting in the Vigo Health Authority (Spain). Original STOPP/START criteria were used, as well as a version adapted to Spanish PHC. Descriptive statistics and generalized linear models were applied.


RESULTS
The median number of medicines per patient was 5 (inter-quartile range: 3-7). The prevalence of PIM identified by the STOPP criteria was 37.5% and 50.7%, with the original criteria and the Spanish version, respectively. Using both versions of the START tool, the prevalence of under-prescription was 45.9% and 43.0%, respectively. A significant correlation was found between the number of STOPP PIM and number of prescriptions, and between the number of START PIM with Charlson comorbidity index and number of prescriptions. Of 87 criteria, 20 accounted for 80% of PIM.


CONCLUSIONS
According to STOPP/START criteria, there is a high level of PIM in PHC setting. To prevent PIM occurring, action must be taken.
Vigo Primary Care Region, Galician Health Service , Vigo , Spain.
Alicia
A
Castillo-Páramo
Ana
A
Clavería
Asunción
A
Verdejo González
Isabel
I
Rey Gómez-Serranillos
M Carmen
MC
Fernández-Merino
Adolfo
A
Figueiras
D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D061214:Patient Safety / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D011320:Primary Health Care; D012307:Risk Factors; D013030:Spain
Inappropriate prescribing; STOPP/START criteria; aged; patient safety; primary health care