A comparison of prescribing criteria when applied to older community-based patients

Background: Studies have compared prescribing criteria for older people in general terms, reporting the findings without true side-by-side comparisons of the frequency and type of potential drug-related problems (DRPs). Objective The aim of this study was to compare the frequency and type of DRPs identified by several prescribing criteria. Additionally, original pharmacist DRP findings were compared with DRPs identified using the prescribing criteria.

Method: Three prescribing criteria were automated: Beers 2012 (Beers), Screening Tool of Older Person’s Prescriptions/ Screening Tool to Alert doctors to Right Treatment (STOPP/START), and Prescribing Indicators in Elderly Australians (PIEA). The criteria were applied to medication reviews of 570 ambulatory older Australian patients. DRPs identified by each set of criteria were recorded. Each DRP was assigned a descriptive term which highlighted mainly drug classes and/or diagnoses to provide a meaningful common language for comparison between recorded DRPs. Descriptive terms were used to compare the frequency and type of DRP identified by each set of criteria, as well as against original pharmacists’ findings.

Results: Beers identified 399 DRPs via 21 different descriptive terms, STOPP/START identified 1,032 DRPs via 42 terms, and PIEA identified 1,492 DRPs via 33 terms. The various types of DRPs identified by all of the three prescribing criteria were represented by 53 different terms. When constrained to the same 53 different terms, pharmacists identified 862 DRPs.

Conclusion: Each set of criteria displayed relevance through mutual agreement of known high-risk medication classes in older people. The number and scope of DRPs identified by pharmacists was best represented by STOPP/ START. The application of STOPP/START may be further augmented with relevant criteria from PIEA and Beers.