Pharmacy Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Av. Hippocrate 10, 1200, Brussels, Belgium,
Drugs Aging. 2014 Apr;31(4):291-8. doi: 10.1007/s40266-014-0157-5.
Hospital admissions may provide an opportunity to discontinue potentially inappropriate medications (PIMs) in older patients. Little is known about the effect of using the Screening Tool of Older People's potentially inappropriate Prescriptions (STOPP) in this context. This study aimed to test the hypothesis that specific STOPP recommendations from an inpatient geriatric consultation team (IGCT) to the hospital physician leads to reductions in PIMs for patients at discharge.
This was a randomised controlled study in 146 frail inpatients (in 2011). The intervention consisted of STOPP recommendations made by the IGCT to ward physicians to discontinue PIMs, in addition to the standard geriatric advice.
Intervention (n = 74) and control (n = 72) groups were similar in terms of patient characteristics (median age 85 years; median number of daily drugs, seven) and PIM distribution (68 and 57 PIMs in 53 and 51 % of patients, respectively). At discharge, the reduction in PIMs was twice as high for the intervention group as for the control group (39.7 and 19.3 %, respectively; p = 0.013). The proportion of patients who still had one or more PIM at discharge did not differ between groups. In the 50 patients followed-up a year later, the majority of PIMs that had been stopped during hospitalisation had not been restarted after discharge (17/28; 61 %). The clinical relevance of PIMs identified at baseline in those patients was considered major (29 %), moderate (37 %), minor (5 %), deleterious (8 %), or not assessed (11 %). Discontinuation rate was not associated with clinical importance.
Specific STOPP recommendations provided to hospital physicians doubled the reduction of PIMs at discharge in frail older inpatients. To further improve the appropriateness of prescribing in older patients, clinicians should focus on the STOPP criteria that are of major clinical importance, and general practitioners should be actively involved.
医院入院可能为老年患者提供停止潜在不适当药物（PIM）的机会。在这种情况下，使用老年人潜在不适当处方筛选工具（STOPP）的效果知之甚少。本研究旨在检验以下假设，即住院老年科会诊团队（IGCT）向住院医师提出的特定 STOPP 建议可减少出院患者的 PIM。
这是一项在 146 名虚弱住院患者（2011 年）中进行的随机对照研究。干预措施包括 IGCT 向病房医生提出的停止 PIM 的 STOPP 建议，以及标准的老年科建议。
干预组（n=74）和对照组（n=72）在患者特征（中位年龄 85 岁；中位每日药物数，7 种）和 PIM 分布（分别有 68 和 57 种 PIM 占 53%和 51%的患者）方面相似。出院时，干预组 PIM 减少的比例是对照组的两倍（分别为 39.7%和 19.3%；p=0.013）。出院时仍有 1 种或多种 PIM 的患者比例在两组之间无差异。在随后随访的 50 名患者中，在住院期间停用的 PIM 大部分在出院后未重新开始（17/28；61%）。这些患者在基线时确定的 PIM 的临床相关性被认为是主要（29%）、中度（37%）、轻度（5%）、有害（8%）或未评估（11%）。停药率与临床重要性无关。
向住院医师提供的特定 STOPP 建议使虚弱老年住院患者出院时 PIM 的减少增加了一倍。为了进一步提高老年患者的处方适宜性，临床医生应重点关注具有主要临床重要性的 STOPP 标准，并且应积极参与全科医生。
