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Formiga F.,Hospital Universitari Of Bellvitge | Formiga F.,Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine | Vidal X.,Hospital Universitari Vall ebron | Vidal X.,Autonomous University of Barcelona | And 21 more authors.
Diabetic Medicine | Year: 2016

Aims: To assess inappropriate prescribing in older people with diabetes mellitus during the month prior to a hospitalization, using tools on potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs) and comparing inappropriate prescribing in patients with without diabetes. Methods: In an observational, prospective multicentric study, we assessed inappropriate prescribing in 672 patients aged 75 years and older during hospital admission. The Beers, Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tool to Alert Doctors to Right Treatment (START) criteria and Assessing Care of Vulnerable Elders (ACOVE-3) medicine quality indicators were used. We analysed demographic and clinical factors associated with inappropriate prescribing. Results: Of 672 patients, 249 (mean age 82.4 years, 62.9% female) had a diagnosis of diabetes mellitus. The mean number of prescribing drugs per patient with diabetes was 12.6 (4.5) vs. 9.4 (4.3) in patients without diabetes (P < 0.001). Of those patients with diabetes, 74.2% used 10 or more medications; 54.5% of patients with diabetes had at least one Beers-listed PIM, 68.1% had at least one STOPP-listed PIM, 64.6% had at least one START-listed PPO and 62.8% had at least one ACOVE-3-listed PPO. Except for the Beers criteria, these prevalences were significantly higher in patients with diabetes than in those without. After excluding diabetes-related items from these tools, only STOPP-listed PIMs remained significantly higher among patients with diabetes (P = 0.04). Conclusions: Polypharmacy is common among older patients with diabetes mellitus. Inappropriate prescribing is higher in older patients with diabetes, even when diabetes-related treatment is excluded from the inappropriate prescribing evaluation. © 2016 Diabetes UK.


San-Jose A.,Hospital Universitari Vall dHebron | San-Jose A.,Autonomous University of Barcelona | San-Jose A.,Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine | Agusti A.,Hospital Universitari Vall dHebron | And 20 more authors.
European Journal of Internal Medicine | Year: 2014

Purpose: 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 75 years and olderwere randomly selected after hospital admission for a year. To assess potentially inappropriate medicines (PIMs), the Beers and STOPP criteriawere used and to assess potentially prescribing omissions (PPOs), the START criteria and ACOVE-3 medicine quality indicatorswere used. An analysis to assess factors associated with IP was performed.Results: 672 patients [median age (Q1Q3) 82 (7986) years, 55.9% female] were included. Median prescribed medicines in the month prior to hospitalization were 10(Q1Q3 713). 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 thanwith 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) 4.9625.94], PIMs [OR = 14.16, 95% CI 6.4431.12], Beers-listed PIMs [OR = 8.19, 95% CI 3.0122.28] and STOPP-listed PIMs [OR = 8.21, 95% CI 3.4719.44]. PIMs was the strongest predictor of PPOs [OR = 2.79, 95% CI 1.814.28].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. © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.


San-Jose A.,Autonomous University of Barcelona | San-Jose A.,Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine | Agusti A.,Autonomous University of Barcelona | Vidal X.,Autonomous University of Barcelona | And 31 more authors.
Archives of Gerontology and Geriatrics | Year: 2014

Purpose: There are limited tools to assess potential prescribing omissions (PPOs) or underprescribing in the elderly. The ACOVE project defines comprehensive quality care indicators for older people and some of these indicators focused on appropriate use of medicines. The aim of the present study was to assess the inter-rater reliability between observers using the ACOVE 3 prescribing indicated medications indicators and compare it with the inter-rater reliability obtained for the Screening Tool of Older Person's Prescriptions (STOPP)/Screening Tool to Alert Doctors to Right Treatment (START) criteria. Methods: In the context of an observational and multicentric study of a cohort of 672 patients 75 years and older who were hospitalized in Internal Medicine services of seven Spanish hospitals, an inter-rater reliability study using the ACOVE selected indicators and the STOPP/START criteria was carried out between April 2011 and March 2012. Three patients were randomly selected in each participating hospital, one for each four months of study. Results: A total of 21 patients (mean (SD) age of 84.3 (5.6) years, 57.1% female) were included in the inter-rater reliability study. For the STOPP, START and ACOVE criteria, the median kappa coefficient for the seven hospital analyses was 0.97, 0.92 and 0.95, respectively. Out of 123 total indicators in only 7 (5.7%) was the kappa coefficient value below 0.75. Only for 2 (5.6%) of the 37 studies selected ACOVE quality indicators was the kappa coefficient value less than 0.75. Conclusions: A high inter-rater reliability was obtained for the selected underprescribing quality indicators of ACOVE 3. These quality indicators may be considered a useful tool in detecting underprescribing to the elderly patients. © 2014 Elsevier Ireland Ltd.


PubMed | Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, University of Barcelona, Hospital Universitari Of Bellvitge and Autonomous University of Barcelona
Type: Journal Article | Journal: European journal of clinical pharmacology | Year: 2016

The purpose of this study is to describe the characteristics of older patients treated with psychotropic medicines and the associated factors and to assess their inappropriate use.An observational, prospective study was carried out in 672 elderly patients admitted to seven hospitals for a year. A comparison of sociodemographic characteristics, geriatric variables, multimorbidity and the number of prescribed medicines taken in the preceding month before hospitalization between patients treated with psychotropics and those not treated was performed. To assess factors associated with psychotropics, multivariate logistic regression analyses were performed. Inappropriate use was assessed using the Beers and the STOPP criteria.A total of 57.5% patients (median [Q1-Q3] age 81.7 [78.2-86.1], 65.7% female) were treated with psychotropics (44.2% anxiolytics, 22.6% antidepressants and 10.8% antipsychotics). Independent factors associated with the use of psychotropics were female gender (OR=2.3; CI 95%,1.6-3.5), some degree of disability on admission (slight [OR=2.2; 1.2-4.2], moderate [OR=3.2, 1.6-6.6], severe [OR=3.4; 1.4-8] and very severe [OR=5.1; 2.0-12.8]) and polypharmacy (5-9 medicines [OR=3.0; 1.3-6.9] and 10 medicines [OR=6.0; 2.7-13.6]). The associated factors varied depending on the different types of psychotropics. In patients treated with psychotropics, the percentage of those with at least one Beers (61.6%) or at least one STOPP (71.4%) criteria was significantly higher in comparison with those not treated with psychotropics (30.7 and 47.7%, respectively, p<0.001).Psychotropics are widely used in the elderly population and often their use is inappropriate. Female gender, a poor functional status and polypharmacy, are the characteristics linked to their use. Interventional strategies should be focused on patients with these characteristics.


PubMed | Hospital Universitari Vall ebron, Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine and Hospital Universitari Of Bellvitge
Type: Journal Article | Journal: Diabetic medicine : a journal of the British Diabetic Association | Year: 2016

To assess inappropriate prescribing in older people with diabetes mellitus during the month prior to a hospitalization, using tools on potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs) and comparing inappropriate prescribing in patients with without diabetes.In an observational, prospective multicentric study, we assessed inappropriate prescribing in 672 patients aged 75 years and older during hospital admission. The Beers, Screening Tool of Older Persons Prescriptions (STOPP) and Screening Tool to Alert Doctors to Right Treatment (START) criteria and Assessing Care of Vulnerable Elders (ACOVE-3) medicine quality indicators were used. We analysed demographic and clinical factors associated with inappropriate prescribing.Of 672 patients, 249 (mean age 82.4 years, 62.9% female) had a diagnosis of diabetes mellitus. The mean number of prescribing drugs per patient with diabetes was 12.6 (4.5) vs. 9.4 (4.3) in patients without diabetes (P < 0.001). Of those patients with diabetes, 74.2% used 10 or more medications; 54.5% of patients with diabetes had at least one Beers-listed PIM, 68.1% had at least one STOPP-listed PIM, 64.6% had at least one START-listed PPO and 62.8% had at least one ACOVE-3-listed PPO. Except for the Beers criteria, these prevalences were significantly higher in patients with diabetes than in those without. After excluding diabetes-related items from these tools, only STOPP-listed PIMs remained significantly higher among patients with diabetes (P = 0.04).Polypharmacy is common among older patients with diabetes mellitus. Inappropriate prescribing is higher in older patients with diabetes, even when diabetes-related treatment is excluded from the inappropriate prescribing evaluation.


Vidal X.,Autonomous University of Barcelona | Agusti A.,Autonomous University of Barcelona | Vallano A.,University of Barcelona | Formiga F.,Hospital Universitari Of Bellvitge | And 14 more authors.
European Journal of Clinical Pharmacology | Year: 2016

Purpose: The purpose of this study is to describe the characteristics of older patients treated with psychotropic medicines and the associated factors and to assess their inappropriate use. Methods: An observational, prospective study was carried out in 672 elderly patients admitted to seven hospitals for a year. A comparison of sociodemographic characteristics, geriatric variables, multimorbidity and the number of prescribed medicines taken in the preceding month before hospitalization between patients treated with psychotropics and those not treated was performed. To assess factors associated with psychotropics, multivariate logistic regression analyses were performed. Inappropriate use was assessed using the Beers and the STOPP criteria. Results: A total of 57.5 % patients (median [Q1–Q3] age 81.7 [78.2–86.1], 65.7 % female) were treated with psychotropics (44.2 % anxiolytics, 22.6 % antidepressants and 10.8 % antipsychotics). Independent factors associated with the use of psychotropics were female gender (OR = 2.3; CI 95 %,1.6–3.5), some degree of disability on admission (slight [OR = 2.2; 1.2–4.2], moderate [OR = 3.2, 1.6–6.6], severe [OR = 3.4; 1.4–8] and very severe [OR = 5.1; 2.0–12.8]) and polypharmacy (5–9 medicines [OR = 3.0; 1.3–6.9] and ≥10 medicines [OR = 6.0; 2.7–13.6]). The associated factors varied depending on the different types of psychotropics. In patients treated with psychotropics, the percentage of those with at least one Beers (61.6 %) or at least one STOPP (71.4 %) criteria was significantly higher in comparison with those not treated with psychotropics (30.7 and 47.7 %, respectively, p < 0.001). Conclusions: Psychotropics are widely used in the elderly population and often their use is inappropriate. Female gender, a poor functional status and polypharmacy, are the characteristics linked to their use. Interventional strategies should be focused on patients with these characteristics. © 2016, Springer-Verlag Berlin Heidelberg.


San-Jose A.,Autonomous University of Barcelona | San-Jose A.,Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine | Agusti A.,Autonomous University of Barcelona | Vidal X.,Autonomous University of Barcelona | And 13 more authors.
BMC Geriatrics | Year: 2015

Background: Scientific evidence on treatments of chronic diseases in patients 85 years old or older is very limited, as is available information on inappropriate prescription (IP) and its associated factors. The study aimed to describe medicine prescription, potentially inappropriate medicines (PIM) and potentially prescribing omissions (PPO) and their associated factors on this population. Methods: In the context of an observational, prospective and multicentric study carried out in elderly patients admitted to seven Spanish hospitals for a year, a sub-analysis of those aged 85 years and over was performed. To assess PIMs, the Beers and STOPP criteria were used, and to assess PPOs, the START and the ACOVE-3 criteria were used. To assess factors associated with IP, a multivariate logistic regression analysis was performed. Patients were selected randomly every week on consecutive days from the hospitalization lists. Results: A total of 336 patients were included in the sub-analysis with a median (Q1-Q3) age of 88 (86-90) years. The median medicines taken during the month prior to admission was 10 (7-13). Forty-seven point two per cent of patients had at least one Beers-listed PIM, 63.3% at least one STOPP-listed PIM, 53.6% at least one START-listed PPO, and 59.4% at least one ACOVE-3-listed PPO. Use of benzodiazepines in patients who are prone to falls (18.3%) and omission of calcium and vitamin D supplements in patients with osteoporosis (13.3%) were the most common PIM and PPO, respectively. The main factor associated with the Beers-listed and the STOPP-listed PIM was consumption of 10 or more medicines (OR∈=∈5.7, 95% CI 1.8-17.9 and OR∈=∈13.4, 95% CI 4.0-44.0, respectively). The main factors associated with the START-listed PPO was a non-community dwelling origin (OR 2.3, 95% CI 1.0-5.0), and multimorbidity (OR1.8, 95% CI 1.0-3.1). Conclusions: Prescribed medicines and PIM and PPO prevalence were high among patients 85 years and over. Benzodiazepine use in those who are prone to falls and omission of calcium and vitamin D in those with osteoporosis were the most frequent PIM and PPO, respectively. Factors associated with PIM and PPO differed with polypharmacy being the most important factor associated with PIM. © 2015 San-Jose et al.; licensee BioMed Central.

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