Potentially inappropriate prescribing in older primary care patients

PLoS One. 2014 Apr 24;9(4):e95536. doi: 10.1371/journal.pone.0095536. eCollection 2014.


Objectives: The aim of the study was to determine the rate of Potentially Inappropriate Medicines (PIM) and Potential Prescription Omissions (PPO) according to Screening Tool of Older Person's potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment (STOPP/START) criteria.

Study design: A cross-sectional survey in community pharmacy.

Method: A prospective cross-sectional study was performed, during March-May 2012, in five community pharmacies. Patients aged ≥65 years, who collected one or more prescribed medications, were asked to participate in the study, and an interview was scheduled. Patients were asked to provide their complete medical and biochemical record from their general practitioner.

Results: 509 patients, mean age 74.8±6.5 years, 57.4% female, participated in the study. 164 PIM were identified in 139 patients (27.3%). The most common were: long-term use of long-acting benzodiazepines (20.7%), use of non-steroidal antiinflammatory drugs (NSAID) in patients with moderate-severe hypertension (20.1%), use of theophylline as monotherapy for chronic obstructive pulmonary disease (COPD, 15.9%) and use of aspirin without appropriate indication (15.2%). Patients with more than four prescpritions had a higher risk for PIM (OR 2.85, 95% CI 1.97-4.14, p<0.001). There were 439 PPO, identified in 257, (50.5%) patients. Predictors for PPO were older age, presence of diabetes, myocardial infarction, osteoporosis, stroke, COPD and/or angina pectoris.

Conclusion: STOPP/START criteria may be useful in identifying inappropriate prescribing and improving the current prescribing practices. Pharmacists should focus more on patients with more than four medications and/or patients with gout or pain accompanied with arterial hypertension because those patient may be at higher risk of PIM. Additionlly, patients older than 74 years with diabetes, osteoporosis, myocardial infarction, stroke, angina pectoris and/or COPD may have an increased risk of PPO.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cross-Sectional Studies
  • Drug Prescriptions
  • Female
  • Humans
  • Inappropriate Prescribing / statistics & numerical data*
  • Male
  • Practice Patterns, Physicians'
  • Primary Health Care
  • Prospective Studies
  • Risk

Grant support

This work was conducted as a part of the project Experimental and Clinical Pharmacological Investigations of Mechanisms of Drug Action and Interactions in Nervous and Cardiovascular System (No. 175023) funded by Ministry of Education, Science and Technological Development, Belgrade, Republic of Serbia. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.