title: Inappropriate prescribing to older patients admitted to hospital: a comparison of different tools of misprescribing and underprescribing.
abstract: OBJECTIVE
  This study aims to assess inappropriate prescribing (IP) to elderly patients during the month prior to hospitalization and to compare different IP criteria.
  
  
  METHODS
  An observational, prospective and multicentric study was carried out in the internal medicine services of seven Spanish hospitals. Patients aged 75years and older were randomly selected after hospital admission for a year. To assess potentially inappropriate medicines (PIMs), the Beers and STOPP criteria were used and to assess potentially prescribing omissions (PPOs), the START criteria and ACOVE-3 medicine quality indicators were used. An analysis to assess factors associated with IP was performed.
  
  
  RESULTS
  672 patients [median age (Q1-Q3) 82 (79-86) years, 55.9% female] were included. Median prescribed medicines in the month prior to hospitalization were 10(Q1-Q3 7-13). The prevalence of IP was 87.6%, and 54.3% of patients had PIMs and PPOs concurrently. A higher prevalence rate of PIMs was predicted using the STOPP criteria than with the Beers criteria (p<0.001) and a higher prevalence of PPOs using the ACOVE-3 criteria than using the START criteria (p<0.001) was observed. Polypharmacy (≥ 10 medicines) was the strongest predictor of IP [OR=11.34 95% confidence interval (CI) 4.96-25.94], PIMs [OR=14.16, 95% CI 6.44-31.12], Beers-listed PIMs [OR=8.19, 95% CI 3.01-22.28] and STOPP-listed PIMs [OR=8.21, 95% CI 3.47-19.44]. PIMs was the strongest predictor of PPOs [OR=2.79, 95% CI 1.81-4.28].
  
  
  CONCLUSIONS
  A high prevalence of polypharmacy and PIMs and PPOs were reported. More than half the patients had simultaneous PIMs and PPOs. The related factors to PIMs and PPOs were different.
authors.affiliation: Internal Medicine Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Spain. Electronic address: asanjose@vhebron.net.
authors.forename: Antonio
authors.initials: A
authors.lastname: San-José
authors.affiliation: Clinical Pharmacology Service, Hospital Universitari Vall D'Hebron,Spain; Fundació Institut Català de Farmacologia, Spain; Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Spain.
authors.forename: Antonia
authors.initials: A
authors.lastname: Agustí
authors.affiliation: Clinical Pharmacology Service, Hospital Universitari Vall D'Hebron,Spain; Fundació Institut Català de Farmacologia, Spain; Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Vidal
authors.affiliation: Internal Medicine Service, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Formiga
authors.affiliation: Internal Medicine Service, Hospital Clínic, Barcelona, Spain; Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: López-Soto
authors.affiliation: Internal Medicine Service, Hospital San Juan De Dios del Aljarafe, Sevilla, Spain; Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Fernández-Moyano
authors.affiliation: Internal Medicine Service, Hospital General Juan Ramón Jiménez, Huelva, Spain; Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Spain.
authors.forename: Juana
authors.initials: J
authors.lastname: García
authors.affiliation: Internal Medicine Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Spain.
authors.forename: Nieves
authors.initials: N
authors.lastname: Ramírez-Duque
authors.affiliation: Universitat Autònoma de Barcelona, Barcelona, Spain; Internal Medicine Service, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Spain.
authors.forename: Olga H
authors.initials: OH
authors.lastname: Torres
authors.affiliation: Internal Medicine Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Barbé
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D008508:Medication Errors; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D011446:Prospective Studies
keywords: Inappropriate prescribing; Older multimorbidity patients; Polypharmacy; Potentially Prescribing Omissions; Potentially inappropriate medicines