The impact of hospitalization on potentially inappropriate prescribing in an acute medical geriatric division

Background Screening Tool of Older Person’s Prescriptions (STOPP) and the Screening Tool to Alert doctors to Right Treatment (START) have been increasingly used to evaluate potentially inappropriate prescriptions (PIPs) and potentially prescription omissions (PPOs). The impact of hospitalization on PIPs/PPOs has not been investigated in depth. Objective To compare the prevalence of PIPs/PPOs in elderly patients on hospital admission and discharge and to identify associated risk factors. Setting An acute medical geriatric division of the Tel Aviv Medical Center (Israel). Method This retrospective cross-sectional study included patients admitted from 12/2011 to 12/2012 aged ≥65 years. Data from patients’ records included demographic details, diagnoses and medications at admission and discharge. STOPP/START criteria were applied to each patient’s record. Main outcome measure Prevalence of PIPs/PPOs on hospital admission and discharge. Results Three hundred patients were included (mean ± SD age 81.9 ± 7.2 years). Admission PIPs prevalence was 39.3 % (118 patients, 172 PIPs) and it increased to 46.0 % (138 patients, 209 PIPs) at discharge (P = 0.009). Admission PPOs prevalence was 41.0 % (123 patients, 153 PPOs) and it decreased to 28.3 % (85 patients, 99 PPOs) at discharge (P < 0.001). Having at least one PIP/PPO at discharge but not at admission was associated with length of hospital stay (OR 1.02, 95 % CI 1.001–1.03). History of falls increased the risk of being a “new PIP patient” (OR 2.25, 95 % CI 1.03–4.9), whereas diabetes increased the risk of being a “new PPO patient” (OR 3.86, 95 % CI 1.2–12.5). Conclusion Hospitalization in a geriatric division resulted in an increase in PIPs and a decrease in PPOs. Strategies to reduce PIPs need to be implemented, especially for patients with longer hospital stay and a history of falls.