DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20175209

Geriatric prescription analysis with respect to “STOPP” and “START” criteria: a descriptive study in the Indian scenario

Mangala B. Murthy, Krishna Jagtap, Shreyas R. Burute, Sunita J. Ramanand, Shraddha M. Pore, Praveenkumar T. Patil

Abstract


Background: Patients; sixty-five years of age and above, are a special risk group as far as drug prescribing is concerned. Prescription irregularities in such patients may be hazardous. STOPP/START criteria are considered as the most up to-date set of explicit criteria for evaluating geriatric prescriptions. To analyse geriatric prescriptions in a tertiary care centre with respect to STOPP/START criteria and WHO core drug prescribing indicators so as to get an idea of pattern of drug prescription in geriatric patients as well as frequency of potentially inappropriate prescriptions. Descriptive cross-sectional study in a tertiary care hospital.

Methods: All inpatients aged 65 years and above who were prescribed at least one allopathic medication and consented to participate in the study were included and patients admitted for medical emergencies were excluded. Demographic data and details of drugs prescribed were collected from prescription chits and indoor case papers.

Results: There was a high frequency of polypharmacy, prescription of antimicrobials and injections. Proportion of patients receiving at least one potentially inappropriate medication (PIM) as per STOPP criteria was 21.01%. Proportion of patients subjected to at least one potential prescribing omission (PPO) as per START criteria was 33.33%. Proportion of patients exposed to potentially inappropriate drug prescriptions as a whole (PIPs=PIMs+PPOs) was 46.37%. Statistical analysis used as descriptive statistics like numbers and percentages were used for data analysis.

Conclusions: With regards to geriatric prescribing, adherence to WHO core prescribing indicators, prescription of drugs as per STOPP and START guidelines are indicative of scope for improvement.


Keywords


Polypharmacy, START criteria, STOPP criteria

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References


Chitra B, Senthilvel N, Sowmya R, Sathyan S and Srisha R: A Study on Prescribing Pattern of Drugs in Geriatrics Using Beers Criteria at a Private Corporate Hospital. Int J Pharm Sci Res. 2015;6(11):4810-25.

Grodzicki BK, Boparai MK, Lichtman SM. Prescribing for Older Patients with Cancer. Clinical Advances in Hematology & Oncology. 2014;12:309-18.

Spinewine A, Schmader KE, Barber N, Hughes C, Lapane KL, Swine C, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised?. Lancet. 2007;370:173-84.

Karandikar YS. Measuring inappropriate prescriptions in geriatric population&58; Overview of various screening tools. International Journal of Medical Research and Health Sciences. 2013;2(3):636-42.

Katzung BG. Special aspects of geriatric pharmacology. Trevor, Anthony J, Bertram G Katzung. Basic and clinical pharmacology. 13th Ed. New York: McGraw Hill, Medical; 2015.

Rognstad S, Brekke M, Fetveit A, Spigset O, Wyller TB, Straand J. The Norwegian General Practice (NORGEP) criteria for assessing potentially inappropriate prescriptions to elderly patients: a modified Delphi study. Scandinavian journal of primary health care. 2009;27(3):153-9.

Marriott J, Stehlik P. A critical analysis of the methods used to develop explicit clinical criteria for use in older people. Age and Ageing. 2012;41:441-50.

Kashyap M, Iqbal MZ. A review of screening tools used for the assessment of appropriateness of prescription’s among elderly patients. Journal of Pharmaceutical and Biomed Sciences. 2014:72-9.

Shah RB, Gajjar BM, Desai SV. Evaluation of the appropriateness of prescribing in geriatric patients using Beers criteria and Phadke's criteria and comparison thereof. J of Pharmacology & Pharmacotherapeutics. 2011;2(4):248.

Joseph S, Verghese N, Thomas L. A study on prescribing pattern of antihypertensive medications in a tertiary care hospital in Malabar region. Der Pharmacia Lettre. 2014;6(4):132-7.

O’Mahony D, Gallagher P, Ryan C, Byrne S, Hamilton H, Barry P, et al. STOPP & START criteria: a new approach to detecting potentially inappropriate prescribing in old age. European Geriatric Medicine. 2010;1(1):45-51.

Sharma N, Advani U, kulshreshtha S, Parakh R, Bansal A, Sinha RR. Screening of prescriptions in geriatric population in a tertiary care teaching hospital in north India. The J of Phytopharmacology. 2013;2(5):38-45

Jhaveri BN, Tejas KP, Barvaliya MJ, Tripath CB. Drug utilization pattern and pharmacoeconomic analysis in geriatric medical in-patients of a tertiary care hospital of India. J Pharmacol Pharmacother. 2014;5(1):15-20.

Taskeen M, Anitha N, Ali SR, Bharath R, Khan AB. A study on rational drug prescribing pattern in geriatric patients in Hyderabad metropolitan. Journal of Drug Delivery and Therapeutics. 2012;2(5).

Jafrin AL, Kumar P, Udhayalakshmi T, Jayapriya B, Sawadkar MS. Drug utilization patterns of Geriatric patients admitted in the Medicine Department of a Tertiary Care Hospital. International J of Pharmacy & Life Sciences. 2013;4(11).

Galvin R, Moriarty F, Cousins G, Cahir C, Motterlini N, Bradley M, et al. Prevalence of potentially inappropriate prescribing and prescribing omissions in older Irish adults: findings from The Irish LongituDinal Study on Ageing study (TILDA). Eur J Clin Pharmacol. 2014;70(5):599-606.

Dalleur O, Spinewine A, Henrard S, Losseau C, Speybroeck N, Boland B. Inappropriate prescribing and related hospital admissions in frail older persons according to the STOPP and START criteria. Drugs Aging. 2012;29(10):829-37.

Gallagher P, Ryan C, Byrne S, Kennedy J, O'Mahony D. STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. International journal of clinical pharmacology and therapeutics. 2008;46(2):72-83.

Lai HY, Hwang SJ, Chen YC, Chen TJ, Lin MH, Chen LK. Prevalence of the prescribing of potentially inappropriate medications at ambulatory care visits by elderly patients covered by the Taiwanese National Health Insurance program. Clin Ther. 2009;31(8):1859-70.

Pyszka LL, Seys Ranola TM, Milhans SM. Identification of inappropriate prescribing in geriatrics at a Veterans Affairs hospital using STOPP/START screening tools. Consult Pharm. 2010;25(6):365-73.