Potentially inappropriate prescribing (PIP) in long-term care (LTC) patients: validation of the 2014 STOPP-START and 2012 Beers criteria in a LTC population--a protocol for a cross-sectional comparison of clinical and health administrative data

Lise M Bjerre, Roland Halil, Christina Catley, Barbara Farrell, Matthew Hogel, Cody D Black, Margo Williams, Cristín Ryan, Douglas G Manuel, Lise M Bjerre, Roland Halil, Christina Catley, Barbara Farrell, Matthew Hogel, Cody D Black, Margo Williams, Cristín Ryan, Douglas G Manuel

Abstract

Introduction: Potentially inappropriate prescribing (PIP) is frequent and problematic in older patients. Identifying PIP is necessary to improve prescribing quality; ideally, this should be performed at the population level. Screening Tool of Older Persons' potentially inappropriate Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) and Beers criteria were developed to identify PIP in clinical settings and are useful at the individual patient level; however, they are time-consuming and costly to apply. Only a subset of these criteria is applicable to routinely collected population-level health administrative data (HAD) because the clinical information necessary to implement these tools is often missing from databases. The performance of subsets of STOPP/START and Beers criteria in HAD compared with clinical data from the same patients is unknown; furthermore, the performance of the updated 2014 STOPP-START and 2012 Beers criteria compared with one another is also unknown.

Methods and analysis: A cross-sectional study of linked HAD and clinical data will be conducted to validate the subsets of STOPP/START and Beers criteria applicable to HAD by comparing their performance when applied to clinical and HAD for the same patients. Eligible patients will be 66 years and over and recently admitted to 1 of 6 long-term care facilities in Ottawa, Ontario. The target sample size is 275, but may be less if statistical significance can be achieved sooner. Medication, diagnostic and clinical data will be collected by a consultant pharmacist. The main outcome measure is the proportion of PIP missed by the subset of STOPP/START and Beers criteria applied to HAD when compared with clinical data.

Ethics and dissemination: The study was approved by the Ottawa Health Services Network Research Ethics Board, the Bruyère Continuing Care Research Ethics Board and the ethics board of the City of Ottawa Long Term Care Homes. Dissemination will occur via publication, national and international conference presentations, and exchanges with regional, provincial and national stakeholders.

Trial registration number: NCT02523482.

Keywords: EPIDEMIOLOGY; GERIATRIC MEDICINE.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
Relation between medication assessment tools, data sources and study objectives. PIP, potentially inappropriate prescribing; STOPP/START, Screening Tool of Older Persons’ potentially inappropriate Prescriptions/Screening Tool to Alert doctors to Right Treatment.
Figure 2
Figure 2
Study participant selection process (LTC, long-term process).
Figure 3
Figure 3
Frequency distribution of PIP by medication assessment tool. PIP, potentially inappropriate prescribing; STOPP/START, Screening Tool of Older Persons’ potentially inappropriate Prescriptions/Screening Tool to Alert doctors to Right Treatment.

References

    1. Fick DM, Cooper JW, Wade WE et al. . Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 2003;163:2716–24. 10.1001/archinte.163.22.2716
    1. Spinewine A, Schmader KE, Barber N et al. . Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet 2007;370:173–84. 10.1016/S0140-6736(07)61091-5
    1. Hutchison LC, O'Brien CE. Changes in pharmacokinetics and pharmacodynamics in the elderly patient. J Pharm Pract 2007;20:4–12. 10.1177/0897190007304657
    1. Laroche ML, Charmes JP, Nouaille Y et al. . Is inappropriate medication use a major cause of adverse drug reactions in the elderly? Br J Clin Pharmacol 2007;63:177–86. 10.1111/j.1365-2125.2006.02831.x
    1. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998;279:1200–5. 10.1001/jama.279.15.1200
    1. Hamilton H, Gallagher P, Ryan C et al. . Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients. Arch Intern Med 2011;171:1013–19. 10.1001/archinternmed.2011.215
    1. Patterson S, Hughes C, Kerse N et al. . Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev 2012;(5):CD008165 10.1002/14651858.CD008165.pub2
    1. Goltz L, Kullak-Ublick GA, Kirch W. Potentially inappropriate prescribing for elderly outpatients in Germany: a retrospective claims data analysis. Int J Clin Pharmacol Ther 2012;50:185–94. 10.5414/CP201441
    1. 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 Pharmacol Pharmacother 2011;2:248–52. 10.4103/0976-500X.85948
    1. The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society Updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2012;60:616–31. 10.1111/j.1532-5415.2012.03923.x
    1. O'Mahony D, O'Sullivan D, Byrne S et al. . STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing 2014;44:213–18. 10.1093/ageing/afu145
    1. Levy HB, Marcus EL, Christen C. Beyond the beers criteria: a comparative overview of explicit criteria. Ann Pharmacother 2010;44:1968–75. 10.1345/aph.1P426
    1. Gallagher P, Ryan C, Byrne S et al. . STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) Consensus validation. Int J Clin Pharmacol Ther 2008;46:72–83. 10.5414/CPP46072
    1. Gallagher PF, O'Connor MN, O'Mahony D. Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria. Clin Pharmacol Ther 2011;89:845–54. 10.1038/clpt.2011.44
    1. Page RL, Linnebur SA, Bryant LL et al. . Inappropriate prescribing in the hospitalized elderly patient: defining the problem, evaluation tools, and possible solutions. Clin Interv Aging 2010;5:75–87. 10.2147/CIA.S9564
    1. Luo R, Scullin C, Mullan AM et al. . Comparison of tools for the assessment of inappropriate prescribing in hospitalized older people. J Eval Clin Pract 2012;18:1196–202. 10.1111/j.1365-2753.2011.01758.x
    1. O'Mahony D, Gallagher P, Ryan C et al. . STOPP & START criteria: a new approach to detecting potentially inappropriate prescribing in old age. Eur Geriatr Med 2010;1:45–51. 10.1016/j.eurger.2010.01.007
    1. Curtain CM, Bindoff IK, Westbury JL et al. . A comparison of prescribing criteria when applied to older community-based patients. Drugs Aging 2013;30:935–43. 10.1007/s40266-013-0116-6
    1. Dimitrow MS, Airaksinen MSA, Kivelä S-L et al. . Comparison of prescribing criteria to evaluate the appropriateness of drug treatment in individuals aged 65 and older: a systematic review. J Am Geriatr Soc 2011;59:1521–30.
    1. Cahir C, Fahey T, Teeling M et al. . Potentially inappropriate prescribing and cost outcomes for older people: a national population study. Br J Clin Pharmacol 2010;69:543–52. 10.1111/j.1365-2125.2010.03628.x
    1. Bradley M, Fahey T, Cahir C et al. . Potentially inappropriate prescribing and cost outcomes for older people: a cross-sectional study using the Northern Ireland Enhanced Prescribing Database. Eur J Clin Pharmacol 2012;68:1–9. 10.1007/s00228-011-1089-1
    1. Bradley M, Motterlini N, Padmanabhan S et al. . Potentially inappropriate prescribing among older people in the United Kingdom. BMC Geriatr 2014;14:72 10.1186/1471-2318-14-72
    1. Beers MH, Ouslander JG, Rollingher I et al. . Explicit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med 1991;151:1825 10.1001/archinte.1991.00400090107019
    1. Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch Intern Med 1997;157:1531–6. 10.1001/archinte.1997.00440350031003
    1. Fick DM, Semla TP. 2012 American Geriatrics Society Beers Criteria: new year, new criteria, new perspective. J Am Geriatr Soc 2012;60:614–15. 10.1111/j.1532-5415.2012.03922.x
    1. Resnick B, Pacala JT. 2012 Beers criteria. J Am Geriatr Soc 2012;60:612–13. 10.1111/j.1532-5415.2012.03921.x
    1. Marcum ZA, Hanlon JT. Commentary on the new American Geriatric Society Beers Criteria for Potentially Inappropriate Medication use in older adults. Am J Geriatr Pharmacother 2012;10:151 10.1016/j.amjopharm.2012.03.002
    1. Page RL, Ruscin JM. The risk of adverse drug events and hospital-related morbidity and mortality among older adults with potentially inappropriate medication use. Am J Geriatr Pharmacother 2006;4:297–305. 10.1016/j.amjopharm.2006.12.008
    1. Ministry of Health and Long Term Care. Ontario Drug Benefit Program: once you turn age 65. 2008. (accessed Aug 2015).
    1. Bronskill S, Gill S, Paterson J et al. . Exploring variation in rates of polypharmacy across long term care homes. J Am Med Dir Assoc 2012;13:309.e15–21. 10.1016/j.jamda.2011.07.001
    1. Institute for Clinical Evaluative Sciences (ICES). Health Services Data. 2011.
    1. Norman GR, Streiner DL. Biostatistics: the bare essentials. 3rd edn Shelton, CT: Peoples’ Medical Publishing House, 2008:241.
    1. Lachin J. Power and sample size evaluation for the McNemar test with application to matched case-control studies. Stat Med 1992;11:1239–51. 10.1002/sim.4780110909

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