Analysis of Potentially Inappropriate Prescriptions (PIP) Based on STOPP/START Criteria in Geriatric Patients with Cardiovascular Disorders at Hasan Sadikin Hospital, Bandung, West Java, Indonesia
Abstract
The geriatric population in Indonesia is increasing rapidly every year. The large number of drugs consumed by geriatric patients results in potentially inappropriate prescriptions (PIP) in the form of mis-prescribing drugs (potentially inappropriate medicines or PIM) and under-prescribing drugs (potentially prescription omission or PPO). In Indonesia, especially in Bandung, there is limited research on PIP in geriatric patients with cardiovascular disorders (CVDs). This study aims to identify PIP and factors that influence PIM and PPO based on STOPP/START criteria and the relationship between the incidence of PIM and kidney function in geriatric inpatients with CVDs at Hasan Sadikin Hospital, Bandung, West Java, Indonesia. The present retrospective study was cross-sectionally conducted from January to December 2022. The Chi-square tests were carried out to determine factors that were significantly related to PIM and PPO. Of the 192 patients, 33.4% patients experienced PIM with the most being NSAIDs with eGFR <30 mL/min/1.73 m2 (36%). As many as 35% of patients experienced PPO with the most frequent PPO not being given angiotensin-converting enzyme inhibitor (ACEi) in patients with systolic heart failure (41.8%). Factors that were significantly associated with PIM were comorbid kidney dysfunctions (OR 5; 95% CI: 2.367-10.342), and no factors were found that were significantly associated with PPO. Taking everything into consideration, it was found that PIM and PPO were common in hospitalized geriatric patients with CVDs. Kidney dysfunctions are a risk factor for PIM. These findings suggest that it is important to evaluate prescribing for geriatric patients during hospitalization using STOPP/START criteria to reduce the prevalence of PIP
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United Nations Department of Economic and Social Affairs, Population Division (2020). World
Population Ageing 2020 Highlights: Living arrangements of older persons (ST/ESA/SER.A/451).
Statistics Indonesia. Statistics of Aging Population 2020. Available online: https://www.bps.go.id/publication/2020/12/21/0fc023221965624a644c1111/statistik-penduduk-lanjut- usia-2020.html (accessed on 09 September 2023).
Statistics Indonesia. Statistics of Aging Population 2021. Available at: https://www.bps.go.id/publication/2021/12/21/c3fd9f27372f6ddcf7462006/statistik-penduduk-lanjut-usia-2021.html [accessed on September 2023].
MacMahon, S.; Calverley, P.; Chaturvedi, N.; Chen, Z.; Corner, L.; Davies, M.; Ezzati, M.; Guthrie, B.; Hanson, K.; Jha, V.; et al. Multimorbidity: a priority for global health research. 2018.
Salive, M.E. Multimorbidity in Older Adults. Epidemiological Reviews. 2013;35:75-83. https://doi.org/10.1093/epirev/mxs009
Rochon, P. A.; Petrovic, M.; Cherubini, A.; Onder, G.; O'Mahony, D.; Sternberg, S.A.; Stall, N.M.; Gurwitz, J.H. Polypharmacy, inappropriate prescribing, and deprescribing in older people: through a sex and gender lens. The Lancet Healthy Longevity. 2021;2(5):e290–e300. https://doi.org/10/1016/S2666-7568(21)00054-4
Lavan, A.H.; Gallagher, P.F.; O'Mahony, D. Methods to reduce prescribing errors in elderly patients with multimorbidity. Clinical Interventions in Aging. 2016;11:857–866. https://doi.org/10.2147/CIA.S80280
O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. Gallagher. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age and Ageing. 2015;44(2):213-218. https://doi.org/10.1093/ageing/afu145
Manias, E.; Kusljic, S.; Lam, D.L. Use of the Screening Tool of Older Persons' Prescriptions (STOPP) and the Screening Tool to Alert doctors to the Right Treatment (START) in hospitalised older people. Australian Journal on Ageing. 2015;34(4):252-258. https://doi.org/10.1111/ajag.12186
Manias, E.; Maier, A.; Krishnamurthy, G. Inappropriate medication use in hospitalised oldest old patients across transitions of care. Aging Clinical and Experimental Research. 2019;31(11):1661–1673. https://doi.org/10.1007/s40520-018-01114-1
Mekonnen, A.; Redley, B.; Crawford, K.; Jones, S.; de Courten, B.; Manias, E. Associations between hyper- polypharmacy and potentially inappropriate prescribing with clinical and functional outcomes in older adults. Expert Opinion on Drug Safety. 2022;21(7):985-994. http://doi.org/10.1080/14740338.2022.2044786
Julaiha, S.; Riyanto, R.; Pardilawati, C.Y. Factors related to the occurrence of potentially inappropriate medication (PIM) based on the STOPP/START criteria in geriatric patients with cardiovascular diseases. Jurnal Kesehatan. 2021;14(2):156-167. https//doi.org/10.26630/jkm.v14i2.3011
Fauziyah, S.; Andrajati, R.; Sartika, R.A.D.; Radji, M. Adaptation and validation of the Screening Tool of Older People's Prescriptions instrument for the Indonesian population. Journal of Research in Pharmacy Practice. Res Pharm Pract. 2020;9(1):24-29. https://doi.org/10.4103/jrpp.JRPP_19_106
Herawati, F.; Maharjana, I.B.N.; Kuswardhani, T.; Susilo, A.P. STOPP-START medication review: A non-rando randomized trial in an Indonesian tertiary hospital to improve medication appropriateness and to reduce the length of stay of older adults. Hospital pharmacy. 2021;56(6):668-677. https://doi.org/10.1177/0018578720942227
Abdulah, R.; Insani, W.N.; Destiani, D.P.; Rohmaniasari, N.; Mohenathas, N.D.; Barliana, M.I. Polypharmacy leads to increased prevalence of potentially inappropriate medication in the Indonesian geriatric population visiting primary care facilities. Therapeutics and Clinical Risk Management. 2018;14:1591-1597. https://doi.org/10.2147%2FTCRM.S170475
Rusdi, N.; Komariah, D.; Wulandari, N. and Roosheroe, A. Identification of Potentially Inappropriate Prescribing in Outpatient Geriatric using STOPP/START Criteria at X Hospital Jakarta. Proceedings of the 1st Muhammadiyah International Conference on Health and Pharmaceutical Development; 2018 Agustus 11; Jakarta: Universitas Prof. Dr. Hamka; 2018.
Wulansari, A.; Wiedyaningsih, C.; Probosuseno. Potentially Inappropriate Medication (PIM) in Geriatric Hospitalized Patients at Dr. H. Moch. Ansari Saleh Regional Public Hospital Banjarmasin. Majalah Farmasi. 2023;19(1):91-98. https://doi.org/10.22146/farmaseutik.v19i1.70420
Tian, F.; Liao, S.; Chen, Z.; Xu, T. The prevalence and risk factors of potentially inappropriate medication use in older Chinese inpatients with multimorbidity and polypharmacy: a cross-sectional study. Annals of translational medicine. 2021;9(18):1483. https://doi.org/10.21037/atm-21-4238
Lee, S. J., Cho, S. W., Lee, Y. J., Choi, J. H., Ga, H., Kim, Y. H., Woo, S. Y., jung, W. S., & Han, D. Y. Survey of Potentially Inappropriate Prescription Using STOPP/START Criteria in Inha University Hospital. Korean Journal of Survey of Family Medicine. 2013;34(5):319-326. https://doi.org/10.4082/kjfm.2013.34.5.319
Mori AL, Carvalho RC, Aguiar PM, et al. Potentially inappropriate prescribing and associated factors in elderly patients at hospital discharge in Brazil: a cross-sectional study. International Journal of Clinical Pharmacy. 2017;39(2):386-393. https://doi.org/10.1007/s11096-017-0433-7
Abegaz TM, Birru EM, Mekonnen GB. Potentially inappropriate prescribing in Ethiopian geriatrics hospitalized with cardiovascular disorders using STOPP/START criteria. PloS One. 2018; 13(5):e0195949. https://doi.org/10.1371/journal.pone.0195949
Teka F, teklay G, Ayalew E, Kassa TT. Prevalence of potentially inappropriate medications in Ayder referral hospital, Tigray region, Northen Ethiopia: prospective study. Journal of Drug Delivery and Therapeutics. 2016;6(6):16-21. https://doi.org/10.22270/jddt.v6i6.1238
Guthrie, B. Can NSAIDs be used safely for analgesia in patients with CKD? Kidney360. 2020;1(11): 1189-1191. https://doi.org/10.34067%2FKID.0005112020
Kidney Disease: Improving Global Outcomes (KDIGO): KDIGO 2012. clinical practice guideline for the evaluation and management of chronic kidney disease. Available at: https://kdigo.org/wp- content/uploads/2017/02/KDIGO_2012_CKD_GL.pdf [accessed on September 2023].
Modig, S.; Elmståhl, S. Kidney function and use of nonsteroidal anti-inflammatory drugs among elderly people: a cross-sectional study on potential hazards for an at-risk population. Internatiional Journal of Clinical Pharmacy. 2018;40(4):870-877. https://doi.org/10.1007%2Fs11096-018-0598-8
Abd ElHafeez, S.; Hegazy, R.; Naga, Y. Wahdan, I.; Sallam, S. Non-steroidal anti-inflammatory drugs among chronic kidney disease patients: an epidemiological study. The Journal of The Egyptian Public Health Association. 2019;94(1):8. https://doi.org/10.1186/s42506-018-0005-2
Getachew, H.; Bhagavathula, A.S.; Abebe, T.B.; Belachew, S.A. Inappropriate prescribing of antithrombotic therapy in Ethiopian elderly population using updated 2015 STOPP/START criteria: a cross-sectional study. Clinical Intervention in Aging. 2016; 11: 819–827. https://doi.org/10.2147/CIA.S107394
Young, F.; Maguire, S. Physiology of ageing. Anaesthesia. Intensive Care Medicine. 2019;20(12):735-738. https://doi.org/10.1016/j.mpaic.2019.10.006
Sipos, M.; Farcas, A.; Leucuta, D.C.; Bulik, N.B.; Huruba, M.; Dumitrascu, D.; Mogosan, C. Prevalence and Risk Factors Associated with Potentially Inappropriate Prescribing According to STOPP-2 Criteria among Discharged Older Patients-An Observational Retrospective Study. Pharmaceuticals (Basel, Switzerland), 2023;16(6):852. https://doi.org/10.3390/ph16060852
Thürmann P.A. Pharmacodynamics and pharmacokinetics in older adults. Current Opinion in Anaesthesiology. 2020;33(1):109-113. https://doi.org/10.1097/aco.0000000000000814
DOI: https://doi.org/10.15416/pcpr.v8i3.50436
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