Potential prescribing omissions vs polypharmacy among elderly patients

Objective: Screening tools have been formulated to identify potentially inappropriate prescribing (PIP) in older people. Screening Tool of Older Person’s Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) have been developed to identify PIP and potential prescribing omissions (PPOs). Although there are many publications on PIP, very few studies have analyzed the omissions. The aim was to measure the prevalence rates of potential PPOs using START. Methods: A cross-sectional study was undertaken on a total of 407 patients aged 65 years or older, who accepted face-to-face questionnaires. Study setting: 15 public primary care centers in Lanzarote (Spain). Data recorded included socio-demographic characteristics, clinical status, functional and cognitive assessment, and complete information about drugs intake. Polypharmacy was defined as treatment with five or more medications. POPs were evaluated according to START criteria. Results: Mean age was 79.3; 57.2% were females. The average CCI was 1.95 and 34.6% of the patients had CCI scores >2. Total number of medicines prescribed was 1831 (median 4.5±2.9). 183 (45%) of outpatients were polimedicated. The most widely prescribed ATC groups were C (69.5% of the patients had at least one drug from this group), A (53.6%) and N (51.6%). A total of 303 PPOs were identified in 41.85% (170) of patients. The most common were metmorfin with Type 2 diabetes (DM) ± metabolic syndrome (24%), statin therapy in DM if coexisting major cardiovascular risk factors present (13%) and antiplatelet therapy in DM with co-existing major cardiovascular risk factors (7.5%). The risk of PPOs increased with an increasing number of drugs (OR 1.21, 95% CI 1.12-1.32) and with the presence of cardiovascular disease (OR 1.67, 95% CI 1.01-2.87). Conclusion: Although polypharmacy rates are high, we detected a significant percentage of potentially beneficial treatment omissions, mainly in endocrine and cardiovascular systems.Universidad de Málaga. Campus de Excelencia Internacional andalucia Tec