JMIR Publications

ABSTRACT

Background:

Multimorbidity is a global health problem that is usually associated with polypharmacy, which increases the risk of potentially inappropriate prescribing (PIP). PIP entails higher hospitalization rates, mortality, and usage of services provided by the health system. There are tools to improve prescription and decrease PIP, such as explicit criteria that can be applied in an automatized manner.

Objective:

The aim of this study was to describe the prevalence of PIP in primary care consultations in the population aged 65–75 years with multimorbidity and polypharmacy, detected by an electronic clinical-decision support system (ECDSS) following the 2015 criteria by the AGS Beers and the European Screening Tool of Older Person’s Prescription and Screening Tool to Alert doctors to the Right Treatment (STOPP/START).

Methods:

Observational, descriptive, cross-sectional study. The sample included 593 community-dwelling elderly aged 65 to 75 years, with multimorbidity (≥ 3 diseases) and polypharmacy (≥ 5 medications), who had visited their primary care doctor at least once over the last year at one of the 38 healthcare centers participating in the Multi-PAP trial. Socio-demographic data, clinical and pharmacological-treatment variables, and PIP, as detected by one ECDSS, were recorded. A multivariate logistic regression model with robust estimators was built to assess factors affecting PIP according to the STOPP criteria.

Results:

PIP was detected in 57.0% of patients according to the STOPP (338/593, CI 95%: 53–61) and 72.8% according to the Beers criteria (432/593, CI 95%: 69.3–76.4), whereas 42.8% met some of the START criteria (254/593, CI 95%: 38.9–46.8). The most frequently detected PIP using the STOPP version 2 was benzodiazepines intake for more than four weeks (217/593, 36.6%) and the prolonged use of a proton-pump inhibitors (269/593, 45.4%) with the Beers 2015. Being a woman (OR=1.43, CI 95%: 1.01–2.01; p=0.04), taking a greater number of medicines (OR=1.25, CI 95%: 1.14–1.37; p<0.001), working in the primary-sector (OR=1.91, CI 95%: 1.25–2.93; p=0.003), and being prescribed with drugs for the central nervous system (OR=3.75 CI 95%: 2.45-5.76; p<0.001) were related to a higher frequency of PIP.

Conclusions:

There is a high prevalence of PIP in primary care as detected by an ECDSS in community-dwelling young-elderly with comorbidity and polypharmacy. The specific PIP criteria defined by this study are consistent with the current literature. This ECDSS can be useful for supervising prescriptions in primary healthcare consultations. Clinical Trial: NCT02866799