Nauta, K. (2014) Potentiële medicatie-gerelateerde problemen bij ouderen met polyfarmacie; de mogelijkheden van de Nederlandse START/STOP criteria om deze op een geaggregeerd niveau te detecteren en hun prevalentie te beschrijven. thesis, Medicine.
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Abstract
Aims: The START/STOP-criteria have been developed to identify potential drug-related problems (START/STOP-signals) in elderly with polypharmacy and recently have been incorporated in the Dutch multidisciplinary guideline on polypharmacy in older patients (2012). The aim of this study is to evaluate the applicability of the START/STOP criteria to detect potential drug-related problems in aggregated GP- data of older patients with polypharmacy and describe the prevalence of START/STOP-signals. Methods: A cross sectional analysis was performed on morbidity data and prescription data of the year 2012 of elderly patients (65+) with polypharmacy (chronic use of ≥ 5 medications), selected from the RNG-database (Registration Network Groningen); a longitudinal database, consisting of information retrieved from GP-databases in the Northern Netherlands, containing data of 29.396 patients. Criteria were operationalized with ICPC main codes (International Classification of Primary Care) and ATC codes (Anatomical Therapeutic Chemical classification), based on existing definitions and, if needed, were further developed by several researchers. The criteria’s applicability was assessed based on the completeness of the RNG-data. The independent association of age, sex and number of chronically used drugs with the prevalence of START/STOP-signals was assessed using multivariate logistic regression analysis. Results: Prescription data of 1.626 older patients with polypharmacy were included. Of the 31 START criteria, 22 (71.0%) and 40 (64.5%) of the 62 STOP criteria were applicable. Reasons for the non-applicability of criteria were a lack of information on diseases and/or their severity, followed by a lack of information on contraindications and medication dosages. START criteria generated ≥ 1 alert in 64.6%; STOP criteria generated ≥ 1 alert in 33.5% of the patients. Advanced age, female sex and high numbers of chronically used medications are associated with the prevalence of START- and STOP-signals. Conclusion: Two-thirds of the START/STOP criteria were applicable to the RNG- database; further development of the criteria’s operationalization is needed. The high prevalence of START/STOP-signals found in this study suggest a high need for medication review at the patient level, although it is possible that there is an overestimation of the number of actual inappropriate medications.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Haaijer-Ruskamp, Prof.Dr. F.M. and Schuling, Dr. J. and Groenhof, Dr. F. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:47 |
| Last Modified: | 25 Jun 2020 10:47 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/836 |
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