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

August 19, 2016 | Strategic Insights for Ambulatory Care


​Failing to prescribe medications as indicated by the START list (Screening Tool to Alert doctors to Right Treatment) has strong associations with mortality and hospitalization in community-dwelling adults, but "surprisingly," prescribing medications on the STOPP list (Screening Tool of Older Persons' potentially inappropriate Prescriptions) 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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