Effects of pharmacists' interventions on appropriateness of prescribing and evaluation of the instruments' (MAI, STOPP and STARTs') ability to predict hospitalization--analyses from a randomized controlled trial

PLoS One. 2013 May 17;8(5):e62401. doi: 10.1371/journal.pone.0062401. Print 2013.

Abstract

Background: Appropriateness of prescribing can be assessed by various measures and screening instruments. The aims of this study were to investigate the effects of pharmacists' interventions on appropriateness of prescribing in elderly patients, and to explore the relationship between these results and hospital care utilization during a 12-month follow-up period.

Methods: The study population from a previous randomized controlled study, in which the effects of a comprehensive pharmacist intervention on re-hospitalization was investigated, was used. The criteria from the instruments MAI, STOPP and START were applied retrospectively to the 368 study patients (intervention group (I) n = 182, control group (C) n = 186). The assessments were done on admission and at discharge to detect differences over time and between the groups. Hospital care consumption was recorded and the association between scores for appropriateness, and hospitalization was analysed.

Results: The number of Potentially Inappropriate Medicines (PIMs) per patient as identified by STOPP was reduced for I but not for C (1.42 to 0.93 vs. 1.46 to 1.66 respectively, p<0.01). The number of Potential Prescription Omissions (PPOs) per patient as identified by START was reduced for I but not for C (0.36 to 0.09 vs. 0.42 to 0.45 respectively, p<0.001). The summated score for MAI was reduced for I but not for C (8.5 to 5.0 and 8.7 to 10.0 respectively, p<0.001). There was a positive association between scores for MAI and STOPP and drug-related readmissions (RR 8-9% and 30-34% respectively). No association was detected between the scores of the tools and total re-visits to hospital.

Conclusion: The interventions significantly improved the appropriateness of prescribing for patients in the intervention group as evaluated by the instruments MAI, STOPP and START. High scores in MAI and STOPP were associated with a higher number of drug-related readmissions.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged, 80 and over
  • Health Services for the Aged*
  • Hospitalization / statistics & numerical data
  • Humans
  • Inappropriate Prescribing / statistics & numerical data*
  • Medication Errors / prevention & control*
  • Medication Therapy Management / standards*
  • Pharmacists*
  • Practice Patterns, Physicians' / standards*

Grant support

The study was funded by the non-profit organization Swedish Academy for Pharmaceutical Sciences (one PHD student via annual scholarships). The University Hospital of Uppsala, Uppsala University and The Hospital Pharmacy (Apoteket AB) all co-funded the study by letting all involved physicians and pharmacists in the study participate in meetings and other tasks surrounding the study during work hours. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.