Szoszkiewicz Mikołaj, Deskur-Śmielecka Ewa, Styszyński Arkadiusz, Urbańska Zofia, Neumann-Podczaska Agnieszka, Wieczorowska-Tobis Katarzyna
Geriatric Unit, Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245 Poznan, Poland.
Student Scientific Section of Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245 Poznan, Poland.
J Clin Med. 2024 Oct 10;13(20):6043. doi: 10.3390/jcm13206043.
Multimorbidity, polypharmacy, and inappropriate prescribing are significant challenges in the geriatric population. Tools such as the Beers List, FORTA, and STOPP/START criteria have been developed to identify potentially inappropriate prescribing (PIP). STOPP/START criteria detect both potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). The latest, third version of STOPP/START criteria expands the tool, based on the growing literature. The study aimed to evaluate the prevalence of PIP and the number of PIP per person identified by STOPP/START version 3 and to compare it to the previous version. This retrospective, cross-sectional study enrolled one hundred geriatric patients with polypharmacy from two day-care centers for partially dependent people in Poland. Collected data included demographic and medical data. STOPP/START version 3 was used to identify potentially inappropriate prescribing, whereas the previous version served as a reference. STOPP version 3 detected at least one PIM in 73% of the study group, a significantly higher result than that for version 2 (56%). STOPP version 3 identified more PIMs per person than the previous version. Similarly, START version 3 had a significantly higher prevalence of PPOs (74% vs. 57%) and a higher number of PPOs per person than the previous version. The newly formed STOPP criteria with high prevalence were those regarding NSAIDs, including aspirin in cardiovascular indications. Frequent PPOs regarding newly formed START criteria were the lack of osmotic laxatives for chronic constipation, the lack of mineralocorticoid receptor antagonists, and SGLT-2 inhibitors in heart failure. This study showed the high effectiveness of the STOPP/START version 3 criteria in identifying potentially inappropriate prescribing, with a higher detection rate than version 2.
多重疾病、多种药物治疗及不适当处方是老年人群面临的重大挑战。已开发出如《比尔斯清单》、FORTA及STOPP/START标准等工具来识别潜在不适当处方（PIP）。STOPP/START标准既能检测潜在不适当药物（PIM），也能检测潜在处方遗漏（PPO）。基于不断增加的文献，最新的第三版STOPP/START标准对该工具进行了扩展。本研究旨在评估PIP的患病率以及STOPP/START第3版识别出的每人PIP数量，并将其与上一版进行比较。这项回顾性横断面研究纳入了波兰两家部分失能日间护理中心的100名使用多种药物治疗的老年患者。收集的数据包括人口统计学和医学数据。使用STOPP/START第3版来识别潜在不适当处方，而上一版作为对照。STOPP第3版在73%的研究组中检测到至少一种PIM，这一结果显著高于第2版（56%）。STOPP第3版识别出的每人PIM数量多于上一版。同样，START第3版的PPO患病率显著更高（74%对57%），且每人的PPO数量也多于上一版。新形成的患病率较高的STOPP标准涉及非甾体抗炎药，包括用于心血管适应症的阿司匹林。新形成的START标准中常见的PPO包括慢性便秘时缺乏渗透性泻药、缺乏盐皮质激素受体拮抗剂以及心力衰竭时缺乏钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂。本研究表明，STOPP/START第3版标准在识别潜在不适当处方方面具有很高的有效性，其检测率高于第2版。
