Advertisement

Prevalence of Potentially Inappropriate Medications in Patients With Multimorbidity According to LESS-CHRON and STOPPFrail Criteria

Published:January 03, 2023DOI:https://doi.org/10.1016/j.jamda.2022.12.013

      Abstract

      Objective

      LESS-CHRON (List of Evidence-Based Deprescribing for Chronic Patients) and STOPPFrail (Screening Tool of Older Persons' Prescriptions in Frail adults with limited life expectancy) are criterion-based deprescribing tools. This study aimed to identify the prevalence of potentially inappropriate medications (PIMs) with these tools in an outpatient, polymedicated, older population with multimorbidity.

      Design

      Single-center cross-sectional observational study.

      Setting and Participants

      PIMs and criteria subject to deprescribing identified by each tool were collected in patients who were being followed up on outpatient internal medicine consultation.

      Methods

      PIMs were identified by STOPPFrail and LESS-CHRON criteria reviewing medical histories and pharmacologic treatments of the patients in the electronic health card system. Sociodemographic, clinical, and pharmacologic variables were recorded. A correlation analysis between treatment tools and clinical values was performed using the nonparametric Spearman rho correlation.

      Results

      Eighty-three patients with a median of 14.4 (interquartile range 12-17) prescribed drugs were included. The total number of PIMs identified with LESS-CHRON was 158 vs 127 with STOPPFrail. Eight of the 27 criteria (29.6%) for LESS-CHRON and 15 of the 25 for STOPPFrail were found to be not applicable. A significant correlation was obtained for both tools with the number of prescribed drugs at the time of inclusion. The Profund, Barthel, and Frail-VIG index only showed a significant correlation with LESS-CHRON.

      Conclusion and Implications

      Both tools have shown the capacity to identify PIMs that can be deprescribed in the population studied. However, LESS-CHRON appears to have a greater detection potential in the subgroup of patients analyzed. STOPPFrail brings a certain complementarity in other areas of therapy not covered by LESS-CHRON.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Zemedikun D.T.
        • Gray L.J.
        • Khunti K.
        • Davies M.J.
        • Dhalwani N.N.
        Patterns of multimorbidity in middle-aged and older adults: an analysis of the UK Biobank data.
        Mayo Clin Proc. 2018; 93: 857-866
        • Chudasama Y.V.
        • Khunti K.
        • Gillies C.L.
        • et al.
        Healthy lifestyle and life expectancy in people with multimorbidity in the UK Biobank: A longitudinal cohort study.
        PLoS Med. 2020; 17: e1003332
        • Zazzara M.B.
        • Vetrano D.L.
        • Carfì A.
        • Onder G.
        Frailty and chronic disease.
        Panminerva Med. 2019; 61: 486-492
        • Hanlon P.
        • Nicholl B.I.
        • Jani B.D.
        • Lee D.
        • McQueenie R.
        • Mair F.S.
        Frailty and pre-frailty in middle-aged and older adults and its association with multimorbidity and mortality: a prospective analysis of 493 737 UK Biobank participants.
        Lancet. 2018; 3: 323-332
        • Barnett K.
        • Mercer S.W.
        • Norbury M.
        • Watt G.
        • Wyke S.
        • Guthrie B.
        Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.
        Lancet. 2012; 380: 37-43
        • Bernabeu-Wittel M.
        • Ollero-Baturone M.
        • Nieto-Martín D.
        • García-Morillo S.
        • Goicoechea-Salazar J.
        Patient-centered care for older adults with multiple chronic conditions: these are the polypathological patients!.
        J Am Geriatr Soc. 2013; 61: 475-476https://doi.org/10.1111/jgs.12142
        • Bernabeu Wittel M.
        • Barón Franco B.
        • Murcia Zaragoza J.
        • et al.
        A multi-institutional, hospital-based assessment of clinical, functional, sociofamilial and health-care characteristics of polypathological patients (PP).
        Arch Gerontol Geriatr. 2011; 53: 284-291
        • Page A.T.
        • Falster M.O.
        • Litchfield M.
        • Pearson S.A.
        • Etherton-Beer C.H.
        Polypharmacy among older Australians, 2006-2017: a population-based study.
        Med J Aust. 2019; 211: 71-75
        • Martínez-Sotelo J.
        • Pinteño-Blanco M.
        • García-Ramos R.
        • Llobera-Cànaves J.
        • Cadavid-Torres M.I.
        Pharmacist-led intervention on potentially inappropriate prescription in patients with polypharmacy: PHARM-PC clinical trial protocol.
        Farm Hosp. 2021; 45 (English): 210-215
        • Gallagher J.
        • O’Sullivan D.
        • McCarthy S.
        • et al.
        Structured pharmacist review of medication in older hospitalised patients: a cost-effectiveness analysis.
        Drugs Aging. 2016; 33: 285-294
        • Ulley J.
        • Harrop D.
        • Ali A.
        • Alton S.
        • Fowler Davis S.
        Deprescribing interventions and their impact on medication adherence in community-dwelling older adults with polypharmacy: a systematic review.
        BMC Geriatr. 2019; 19: 15
        • Rodríguez Pérez A.
        • Alfaro Lara E.R.
        • Nieto Martín M.D.
        • Ruiz Cantero A.
        • Santos Ramos B.
        Deprescribing in patients with multimorbidity: A necessary process.
        Eur J Intern Med. 2015; 26: e18-e19
        • Thompson W.
        • Lundby C.
        • Graabæk T.
        • et al.
        Tools for deprescribing in frail older persons and those with limited life expectancy: a systematic review.
        J Am Geriatr Soc. 2019; 67: 172-180
        • Rodríguez Pérez A.
        • Alfaro Lara E.R.
        • Albiñana Pérez S.
        • et al.
        Novel tool for deprescribing in chronic patients with multimorbidity: List of Evidence-Based Deprescribing for Chronic Patients criteria.
        Geriatr Gerontol Int. 2017; 17: 2200-2207
        • Lavan A.
        • Gallagher P.
        • Parsons C.
        • et al.
        STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy): Consensus validation.
        Age Ageing. 2016; 45: 1-12
        • Curtin D.
        • Dukelow T.
        • James K.
        • O'Donnell D.
        • O'Mahony D.
        • Gallagher P.
        Deprescribing in multi-morbid older people with polypharmacy: agreement between STOPPFrail explicit criteria and gold standard deprescribing using 100 standardized clinical cases.
        Eur J Clin Pharmacol. 2019; 75: 427-432
        • Pfeiffer E.
        A short portable mental status questionaire for the assesment of organic brain deficit in elderly patients.
        J Am Geriatr Soc. 1975; 23: 433-441
        • Mahoney F.I.
        • Barthel D.W.
        Functional evaluation: the Barthel Index.
        Md State Med J. 1965; 4: 61-65
        • Bernabeu Wittel M.
        • Moreno Gaviño L.
        • Ollero Baturone M.
        • et al.
        Validation of PROFUND prognostic index over a fouryear follow-up period.
        Eur J Intern Med. 2016; 36: 20-24
        • Amblàs Novellasa J.
        • Martori J.C.
        • Molist Brunet N.
        • Oller R.
        • Gómez-Batiste X.
        • Espaulella Panicot J.
        [Frail-VIG index: Design and evaluation of a new frailty index based on the Comprehensive Geriatric Assessment].
        Rev Esp Geriatr Gerontol. 2017; 52: 119-127
        • Hulley S.B.
        • Cummings S.R.
        • Browner W.S.
        • Grady D.
        • Newman T.B.
        4th ed. Designing clinical research: an epidemiologic approach. 6C. Lippincott Williams & Wilkins, 2013: 79
        • Rodríguez-Pérez A.
        • Alfaro-Lara E.R.
        • Sierra-Torres M.I.
        • et al.
        Validation of the LESS-CHRON criteria: reliability study of a tool for deprescribing in patients with multimorbidity.
        Eur J Hosp Pharm. 2019; 26: 334-338
        • Hyun-Woo Ch
        • Yoonhee K.
        • Yewon S.
        • et al.
        Prevalence of potentially inappropriate medications based on the STOPPFrail criteria in frail older patients with limited life expectancy: a cross-sectional study.
        BMC Geriatr. 2022; 22: 367
        • Curtin D.
        • Gallagher P.
        • O'Mahony D.
        Deprescribing in older people approaching end-of-life: development and validation of STOPPFrail version 2.
        Age Ageing. 2021; 50: 465-471