Potentially inappropriate prescriptions according to explicit and implicit criteria in patients with multimorbidity and polypharmacy. MULTIPAP: A cross-sectional study

Lopez-Rodriguez, Juan A. ; Rogero-Blanco, Eloísa ; Aza-Pascual-Salcedo, Mercedes ; Lopez-Verde, Fernando ; Pico-Soler, Victoria ; Leiva-Fernandez, Francisca ; Prados-Torres, J. Daniel ; Prados-Torres, Alexandra ; Cura-González, Isabel ; Gimeno Feliu Luis (Universidad de Zaragoza) ; on behalf MULTIPAP group

Resumen: Background
Multimorbidity is a global health challenge that is associated with polypharmacy, increasing the risk of potentially inappropriate prescribing (PIP). There are tools to improve prescription, such as implicit and explicit criteria.
Objective
To estimate the prevalence of PIP in a population aged 65 to 74 years with multimorbidity and polypharmacy, according to American Geriatrics Society Beers Criteria® (2015, 2019), the Screening Tool of Older Person’s Prescription -STOPP- criteria (2008, 2014), and the Medication Appropriateness Index -MAI- criteria in primary care.
Methods
This was an observational, descriptive, cross-sectional study. The sample included 593 community-dwelling elderly aged 65 to 74 years, with multimorbidity and polypharmacy, who participated in the MULTIPAP trial. Socio-demographic, clinical, professional, and pharmacological-treatment variables were recorded. Potentially inappropriate prescribing was detected by computerized prescription assistance system, and family doctors evaluated the MAI. The MAI-associated factors were analysed using a logistic regression model.
Results
A total of 4,386 prescriptions were evaluated. The mean number of drugs was 7.4 (2.4 SD). A total of 94.1% of the patients in the study had at least one criterion for drug inappropriateness according to the MAI. Potentially inappropriate prescribing was detected in 57.7%, 43.6%, 68.8% and 71% of 50 patients according to the explicit criteria STOPP 2014, STOPP 2008, Beers 2019 and Beers 2015 respectively. For every new drug taken by a patient, the MAI score increased by 2.41 (95% CI 1.46; 3.35) points. Diabetes, ischaemic heart disease and asthma were independently associated with lower summated MAI scores.
Conclusions
The prevalence of potentially inappropriate prescribing detected in the sample was high and in agreement with previous literature for populations with multimorbidity and polypharmacy. The MAI criteria detected greater inappropriateness than did the explicit criteria, but their application was more complex and difficult to automate.

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Idioma: Inglés

DOI: 10.1371/journal.pone.0237186

Año: 2020

Publicado en: PLoS ONE 15, 8 (2020), e0237186 [20 pp.]
ISSN: 1932-6203

Factor impacto JCR: 3.24 (2020)

Categ. JCR: MULTIDISCIPLINARY SCIENCES rank: 25 / 71 = 0.352 (2020) - Q2 - T2

Factor impacto SCIMAGO: 0.99 - Multidisciplinary (Q1)

Financiación: info:eu-repo/grantAgreement/ES/ISCIII-FEDER/RD16-0001-0004
Financiación: info:eu-repo/grantAgreement/ES/ISCIII/FIS/PI15-00276
Financiación: info:eu-repo/grantAgreement/ES/ISCIII/FIS/PI15-00572
Financiación: info:eu-repo/grantAgreement/ES/ISCIII/FIS/PI15-00996
Financiación: info:eu-repo/grantAgreement/ES/ISCIII/RD16-0001-0005
Financiación: info:eu-repo/grantAgreement/ES/ISCIII/RD16-0001-0006

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)