Potentially Inappropriate Prescription and Impact of Physician Training on Usage of Prescribing Screening Tools for the Elderly in a Secondary Healthcare Facility

Abstract

Background: Potentially Inappropriate Prescribing (PIP) for the elderly is widespread and is a risk factor for increased morbidity and mortality among them. The Beers criteria and “Screening Tools of Other Persons' potentially inappropriate Prescriptions (STOPP) and Screening Tools to Alert doctors to Right Treatment (START) criteria” have been validated to reduce PIP prevalence in the elderly when applied. However, many studies attest that a knowledge gap regarding PIP in geriatrics amongst prescribers contributes to the PIP surge. This study aims to assess the prevalence and predictors of PIP and also the impact of physician training on the usage of common prescribing tools for the elderly in a secondary healthcare facility.

Methods: This study was a retrospective cross-sectional before- and -after study. Case files of 220 ambulatory patients aged 65 years and above were retrieved and screened for Potential Inappropriate Medicines (PIMs) and Potential Prescribing Omissions (PPOs) using the Beers criteria (2019) and STOPP/START criteria (2015). Subsequently a comprehensive training session was held for
physicians on the utilization of the Beers and STOPP/START criteria in geriatric pharmacotherapy and the use of screening tools-based smartphone application (app) in reducing PIP among the elderly. The prevalence and pattern of PIM/PPO before and after the intervention were compared on the same case files 2 months later to determine the impact of the training on the pattern and prevalence of PIP.

Results: The mean age was 73.6±6.1years and 54.5% were males. About 76.1% of the population had multi-morbidity and hypertension was the most common affecting 69.1% of participants while diabetes followed at 13.2%. The mean number of medications observed was 5.49±2.35 per patient before and 5.01±2.22 after the intervention. The most prescribed PIMs according to STOPP and Beers criteria before and after the intervention were methyldopa, glimepiride, and glibenclamide. However, amitriptyline also made the list of the most prescribed Beers drug while the most omitted START drug was regular inhaled corticosteroid for frequent exacerbation requiring systemic corticosteroid. The STOPP PIM prevalence was significantly reduced from 37.7% to 29.1% after intervention (P= 0.045) while the START Potentially PPOs prevalence of 4.5% (P=0.5000) and Beers PIM prevalence of 30% (P=0.3014) were not significantly reduced after the intervention. The overall PIP prevalence was reduced considerably from 24 in 100 patients to 18 in 100 patients (P=0.002) The binary logistic regression indicated that females, lower education, and multimorbidity, patients receiving more than five drugs, and those with active occupation were significant predictors of PIP in this study.

Conclusion: The prevalence of PIP among the elderly was relatively high. Beers and STOPP/START criteria-based educational training coupled with the introduction and installation of a smartphone screening tool application for physicians effectively reduced overall PIP among the elderly. Continuous education in geriatric pharmacotherapy for physicians is necessary to reduce PIP prevalence in the elderly.