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Identification of Inappropriate Prescribing in Geriatrics at a Veterans Affairs Hospital Using STOPP/START Screening Tools

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Objective: Pharmacists' interventions of potentially inappropriate medications (PIM) decrease hospital admissions and emergency department visits and provide health-cost savings. The newest criterion to address PIMs is STOPP/START (Screening Tool of Older Person's Prescriptions/Screening Tool to Alert Doctor's to the Right Treatment). The purpose of this study is to determine the frequency of PIMs in a geriatric population.

Design/Setting/Participants: A retrospective chart review of 511 patients was conducted at a Veterans Affairs hospital in patients > 70 years of age.

Interventions: Charts were reviewed at hospital admission, discharge, and first follow-up clinic visit post-discharge for incidence of STOPP/START medications.

Main Outcome Measure(s): STOPP/START criterion was applied to patients' medication lists and documented with omission or commission medications.

Results: One hundred eleven (22%) patients met inclusion criteria. STOPP/START medication use was similar at all time points. Medications without an appropriate diagnosis were the most common type of STOPP criteria identified. Aspirin (> 150 mg daily) had high frequency of use. Incidence of START was highest with omissions of statin therapy, angiotensin-converting enzyme (ACE) inhibitor with heart failure, and vitamin D in patients with osteoporosis.

Conclusion: The results demonstrated that inappropriate prescribing and omission of medications occurs consistently at all points of care. STOPP/START criteria are more comprehensive than previous inappropriate prescribing lists. Utilization of a clinical pharmacist would benefit patients through elimination of PIMs and identification of medications to optimize patient care.
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Keywords: Adverse drug reactions/effects; Beers list; Elderly; Geriatric; Inappropriate prescribing

Document Type: Research Article

Publication date: 2010-06-01

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  • The Consultant Pharmacist® is the official peer-reviewed journal of the American Society of Consultant Pharmacists. It is dedicated exclusively to the medication needs of the elderly in all settings, including adult day care, ambulatory care, assisted living, community, hospice, and nursing facilities. This award-winning journal is a member benefit of ASCP. Individuals who are not members and wish to receive The Consultant Pharmacist® will want to consider joining ASCP.
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