Prescribing Omissions according to START and related hospital admission in geriatric patients

Objective: To study the performance of START (Screening Tool to Alert doctors to Right Treatment) in detecting prescribing omissions (PO) at home and related acute hospital admission in frail older people. Design: Patients aged ≥75 years with frailty features (ISAR≥2/6) were prospectively assessed by the geriatric liaison team after acute hospital admission. Setting: This study was performed in a 900-bed teaching hospital in Brussels. Main Outcome Measures were PO and PO related-hospital admission, identified independently by a clinical pharmacist and a geriatrician, using the START criteria and comparing medications prescribed at home with medical conditions. Results: 302 frail older persons (84±5 years; ♀ 61%; ISAR 3.5±1) were included. They received at home 2028 medications (6±3). Polymedication (>5/day) was present in 64% persons, falls (last 6 months) in 58%, denutrition in 30%, and cognitive decline in 25%. The most frequent reasons for acute hospital admission were cardio-respiratory symptoms (115) and falls with fracture (103). 362 PO were detected in 189 persons (63%). Three medical conditions (ischemic disease, diabetes, osteoporotic fracture) accounted for 52 % of all PO events. The drugs which were the most frequently omitted were: aspirin (prevalence = 21%), statins (19%), calcium and vitamin D (17%), vitamin K antagonists (11%) and biphosphonates (10%). Hospital admission was related to IP in 38 persons (13%), of whom 19 were admitted for fall with fracture while not receiving fracture prevention (Calcium, vitamin D, biphosphonate). Multivariate analysis showed that previous osteoporotic fracture (p<0.001) and atrial fibrillation (p=0.004) were predictors of PO-related admissions. Conclusions: PO at home was detected in more than half of frail older persons. PO contributed to one in eight acute hospital admissions. Screening for cardiovascular diseases and fall history, as well as for their pharmacological prevention, is of paramount importance in frail older persons. References: P. Gallagher, C. Ryan, S. Byrne, J. Kennedy and D. O’Mahony. STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. International Journal of Clinical Pharmacology and Therapeutics, Vol. 46 – No. 2/2008 (72-83)

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Dalleur, O., Spinewine, A., Henrard, S., Losseau, C., Speybroeck, N., & Boland, B. (2011). Prescribing Omissions according to START and related hospital admission in geriatric patients. 4ème Symposium interdisciplinaire de recherche sur le vieillissement, Bruxelles. https://hdl.handle.net/2078.5/229771