Inappropriate Prescribing: Underuse, but Not Misuse, Linked to Mortality, Hospitalization

July 29, 2016 | Aging Services Risk, Quality, & Safety Guidance

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​Failing to prescribe medications as indicated by the START (Screening Tool to Alert doctors to Right Treatment) list has strong associations with mortality and hospitalization in community-dwelling adults, but "surprisingly," prescribing medications on the STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) list does not, according to a study published on July 18, 2016, in the British Journal of Clinical Pharmacology. The authors studied 503 Belgian community-dwelling adults age 80 and older for 18 months and found that few patients were prescribed medications appropriately. General practitioners were responsible for collecting the baseline and follow-up data. The researchers defined prescribing "underuse" as failing to prescribe medications as indicated by the START list, and they defined prescribing "misuse" as prescribing medications on the STOPP list. Patients with known dementia and those in palliative care were excluded from the study. Underuse of medication occurred in 67% of patients, while misuse occurred in 56%.

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