Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Fixa, A.
Inappropriate drug prescribing in patients with end-stage renal disease:
Feasibility of the „STOPP/START“- screening tool version 2.0 in a cohort of ambulatory haemodialysis patients
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2016. pp. 69
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Roller-Wirnsberger Regina
- Wirnsberger Gerhard
- Altmetrics:
- Abstract:
- Background: STOPP/START criteria are a commonly accepted screening tool to detect inappropriate prescribing in older adults. So far, the test battery has not been tested for its validity in patients undergoing chronic haemodialysis (HD). Objective: The aim of this study was to determine PIPs/PPOs according to STOPP/START criteria, to assess applicability of corresponding recommendations in ambulatory HD patients and to compare findings with the guideline-based and eminence-based medication review performed by a nephrologist using nephrological treatment guidelines. Methods: Retrospective cross-sectional analysis of medication regimen was performed in 62 patients aged = 40 years with end-stage renal disease and undergoing regular haemodialysis (HD) using STOPP/START Version 2 criteria. A guideline-based and eminence-based medication review was separately performed by a nephrologist. Where possible, results of medication reviews of both approaches were compared and diverse results were discussed using a structured interview technique. Results: Using the STOPP criteria 114 PIPs were identified in total. 62/114 PIPs were also detected by the nephrologist’s disease-centred expert review. 30/52 STOPP recommendations, which were not detected during this expert review, were accepted by the nephrologist during the structured interview retrospectively reflecting a more patient-centred clinical approach. The specialist assessed a further 25 drugs as inadequate and ordered their use to be stopped in the study cohort: those included the use of statins (n=15), drugs with transdermal application (n=4), others (n=6). START criteria determined 82 PPOs. The specialist’s overall acceptance of introducing START recommendations was low (11 recommendations, 13.4%). The two main treatments rejected by the nephrologist were oral anticoagulant therapy (START A1, n=13) and statin therapy (START A5, n=20). Conclusion: A specialist’s assessment of a drug regimen in HD patients is comparable in process management to medication management used in STOPP approach. However, looking at medication record content and recommendations, acceptance by specialists, especially of START recommendations elaborated with the new STOPP/START criteria for HD patients, is extremely low. Therefore it may be concluded that START recommendations for HD patients need to be adapted to the needs of this patient population.