Lozano-Montoya Isabel, Vélez-Diaz-Pallarés Manuel, Delgado-Silveira Eva, Montero-Errasquin Beatriz, Cruz Jentoft Alfonso Jose
Servicio de Geriatria, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Servicio de Farmacia Hospitalaria, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Age Ageing. 2015 Sep;44(5):861-6. doi: 10.1093/ageing/afv079. Epub 2015 Jul 13.
the STOPP-START criteria were developed to detect potentially inappropriate prescribing (PIP) in older people. The reasons why multidisciplinary geriatric teams decide not to follow STOPP-START criteria have not been studied.
to analyse compliance with the recommendations of the STOPP-START criteria in older inpatients.
ambispective, non-randomised study. SUBJECTS SETTING: three hundred and eighty-eight consecutive patients aged 80 years or over admitted to the acute geriatric medicine unit of a University hospital.
STOPP-START criteria were systematically used by a pharmacist to assess pre-admission treatments, and the multidisciplinary geriatric team decided what drugs were recommended after discharge. Two researches independently assessed how many STOPP-START recommendations were accepted by the team, and if they were not accepted, why.
two hundred and eighty-four PIPs were identified (0.8 per subject) according to STOPP criteria. Two hundred and forty-seven of these prescriptions (87.0%) were discontinued at discharge. STOPP recommendations were not accepted in 37 cases, mostly because the team considered other therapeutic priorities (lorazepam, n = 12; risperidone, n = 5; other, n = 18). Three hundred and ninety-seven PIPs were identified according to START criteria (1.1 per subject). START recommendations were not followed at discharge in 264 cases (66.5%). The most frequent reasons were as follows: severe disability (n = 90), the use of other effective treatments for the condition (n = 38) and high risk of severe adverse effects (n = 32). Not following START criteria was significantly associated with dependency for basic activities of daily living (ADLs) (odds ratio, OR: 0.66 for compliance with a recommendation; 0.49-0.89), dependency for instrumental ADLs (OR: 0.64; 0.48-0.85) or inability to walk (OR: 0.72; 0.54-0.98).
potentially inappropriate drugs are usually discontinued, but many older hospitalised patients do not receive potentially recommended medications. More research on the reasons and consequences of this fact is needed.
STOPP-START标准旨在检测老年人中潜在的不适当处方（PIP）。多学科老年医学团队不遵循STOPP-START标准的原因尚未得到研究。
分析老年住院患者对STOPP-START标准建议的依从性。
前瞻性、非随机研究。研究对象及地点：一所大学医院急性老年医学科连续收治的388例80岁及以上患者。
由一名药剂师系统地使用STOPP-START标准评估入院前的治疗情况，多学科老年医学团队决定出院后推荐使用哪些药物。两名研究人员独立评估团队接受了多少STOPP-START建议，以及如果未被接受，原因是什么。
根据STOPP标准确定了284例PIP（每位患者0.8例）。其中247例处方（87.0%）在出院时停用。37例中STOPP建议未被接受，主要是因为团队认为有其他治疗重点（劳拉西泮，n = 12；利培酮，n = 5；其他，n = 18）。根据START标准确定了397例PIP（每位患者1.1例）。264例（66.5%）出院时未遵循START建议。最常见的原因如下：严重残疾（n = 90）、针对该病症使用了其他有效治疗方法（n = 38）以及严重不良反应的高风险（n = 32）。不遵循START标准与日常生活基本活动（ADL）依赖显著相关（比值比，OR：遵循建议为0.66；0.49 - 0.89）、工具性ADL依赖（OR：0.64；0.48 - 0.85）或无法行走（OR：0.72；0.54 - 0.98）。
潜在的不适当药物通常会停用，但许多老年住院患者未接受潜在推荐的药物。需要对这一事实的原因和后果进行更多研究。
