title: The Association Between Potentially Inappropriate Prescribing and Medication-Related Hospital Admissions in Older Patients: A Nested Case Control Study.
abstract: BACKGROUND
  Medication-related problems can cause serious adverse drug events (ADEs) that may lead to hospitalization of the patient. There are multiple screening methods to detect and reduce potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). Whether this will result in less medication-related hospitalizations is unknown. The study objective was to assess the risk of preventable medication-related hospital admissions associated with potentially inappropriate prescribing, using the Beers 2012 and the Screening Tool of Older Person's Prescriptions and the Screening Tool to Alert doctors to Right Treatment (STOPP & START) 2008 criteria.
  
  
  METHODS
  A nested case-control study was conducted with a subset of Dutch participants from the Hospital Admissions Related to Medication (HARM) study. Cases were defined as patients aged ≥65 years with a potentially preventable medication-related hospital admission. For each case, one control was selected, matched for age and sex. The primary determinant was the presence of one or more PIMs according to the Beers 2012 and STOPP 2008 criteria. The secondary determinant was the presence of one or more PIMs and PPOs according to the STOPP & START 2008 criteria. The strength of the association between inappropriate prescribing and medication-related hospital admission was evaluated with multivariate logistic regression and expressed as odds ratios (ORs) with 95 % confidence intervals (CIs).
  
  
  RESULTS
  The prevalence of Beers 2012 criteria PIMs in the total cohort was 44.4 %. The prevalence of STOPP & START 2008 criteria PIMs and PPOs were, respectively, 34.1 and 57.7 %. STOPP 2008 criteria PIMs were associated with preventable medication-related hospital admissions [OR adjusted for number of drugs and comorbidities (ORadj) 2.30, 95 % CI 1.30-4.07], whereas there was no association with Beers 2012 criteria PIMs (ORadj 1.49, 95 % CI 0.90-2.47). STOPP PIMs and START PPOs together were also associated with preventable medication-related hospital admissions (ORadj 3.47, 95 % CI 1.70-7.09).
  
  
  CONCLUSIONS
  Our study shows that patients with potentially inappropriate prescribing detected with the STOPP & START 2008 criteria are at risk of preventable medication-related hospital admissions. The STOPP & START 2008 criteria can be used to identify older people at risk of medication-related problems.
authors.affiliation: Department of Clinical Pharmacy, ZANOB, Jeroen Bosch Hospital, PO Box 3406, 5203 DK, 's-Hertogenbosch, The Netherlands. r.v.d.stelt@zanob.nl.
authors.forename: C A K
authors.initials: CA
authors.lastname: van der Stelt
authors.affiliation: Department of Clinical Pharmacy, ZANOB, Jeroen Bosch Hospital, PO Box 3406, 5203 DK, 's-Hertogenbosch, The Netherlands.
authors.forename: A M A
authors.initials: AM
authors.lastname: Vermeulen Windsant-van den Tweel
authors.affiliation: Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.|Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: A C G
authors.initials: AC
authors.lastname: Egberts
authors.affiliation: Department of Clinical Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: P M L A
authors.initials: PM
authors.lastname: van den Bemt
authors.affiliation: Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: Leendertse
authors.affiliation: Department of Clinical Pharmacy, ZANOB, Jeroen Bosch Hospital, PO Box 3406, 5203 DK, 's-Hertogenbosch, The Netherlands.
authors.forename: W A J J
authors.initials: WA
authors.lastname: Hermens
authors.affiliation: Geriatric Department, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.|Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: R J
authors.initials: RJ
authors.lastname: van Marum
authors.affiliation: Department of Clinical Pharmacy, ZANOB, Jeroen Bosch Hospital, PO Box 3406, 5203 DK, 's-Hertogenbosch, The Netherlands.|Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
authors.forename: H J
authors.initials: HJ
authors.lastname: Derijks
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D000067561:Potentially Inappropriate Medication List; D015995:Prevalence