CP-002 Managing polypharmacy in geriatric patients – a comparison of different assessment tools used for medication reviews

Background Geriatric patients often suffer from multiple chronic diseases. Polypharmacy as well as age related physiological changes expose them to a high risk of drug related adverse events. Poor adherence and potentially inappropriate medicines (PIMs) are a further challenge for prescribers. Purpose When performing a medication review, it is important to not only check for overtreatment in order to reduce polypharmacy, but also to include a check for undertreatment and for inappropriate medication. Material and methods Widely recognised tools to assess the medication of geriatric patients are the STOPP (Screening Tool of Older Persons’ Prescriptions)/START (Screening Tool to Alert doctors to Right Treatment) criteria, the Medication Appropriateness Index (MAI) and lists with PIMs. For this study, the medication lists of 50 geriatric patients (level of care ≥3) in a nursing home were analysed in detail using these three instruments. The medication review of each patient was repeated within 6 months to record the acceptance of the interventions. Results Overall, the pharmacist pointed to a possible drug related problem in 28% of all prescribed medicines, equivalent to three possible drug related problems per patient. Over 50% of the interventions suggested by the pharmacist were accepted and kept until the following review. Conclusion The type and number of drug related problems was strongly dependent on the assessment tool. This should be taken into account when introducing an assessment tool into daily routine. It is also important to note that the number of identified problems neither corresponds to the clinical significance of the problem nor to the quality of the medication before the review was performed. To put it bluntly, the mere number of interventions should not be seen as the main indicator of pharmaceutical care. Instead, more weight should be put on the clinical significance of these interventions. References and/or Acknowledgements Gallagher P, Ryan C, Byrne S, et al. STOPP (Screening Tool of Older Persons’ Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus Validation. Int J Clin Pharm Ther 2008;46:72–83 No conflict of interest.