Comparing three criteria for assessment of what medicines included in National Hospital Formulary are classified as potentially inappropriate medication for older patients.

D. RODRIGUES1, M.T. HERDEIRO2, A. ALCOBIA3, J. APERTA4, M. MORGADO5, F. ROQUE1. 1UNIDADE DE INVESTIGAÇÃO PARA O DESENVOLVIMENTO DO INTERIOR, INSTITUTO POLITÉCNICO DA GUARDA (UDI-IPG), GUARDA, PORTUGAL. 2DEPARTAMENTO DE CIÊNCIAS MÉDICAS E INSTITUTO DE BIOMEDICINA, UNIVERSIDADE DE AVEIRO(IBIMED-UA), , AVEIRO, PORTUGAL. 3HOSPITAL GARCIA DE ORTA, PHARMACEUTICAL SERVICES, ALMADA, PORTUGAL. 4UNIDADE LOCAL DE SAÚDE DA GUARDA, PHARMACEUTICAL SERVICES, GUARDA, PORTUGAL. 5CENTRO HOSPITALAR UNIVERSITÁRIO COVA DA BEIRA, PHARMACEUTICAL SERVICES, COVILHÃ, PORTUGAL.

What was done? Why was done?

Through three different tools, we identified which drugs classified as Potentially Some medicines are described as PIM for older patients. At least one PIM is Inappropriate Medication (PIM) are present in the National Hospital Formulary regularly prescribed between 25% to 56% in hospitalized elderlies1 and have of Medicines (FHNM). Information on the Summary of Product Characteristics been associated to adverse drug reactions (ADR) in this population. ADR are (SmPC) about precautions and special conditions of use in elderly patients was responsible for 6–17% of all hospital admissions in older adults2. verified too. How was it done?

For all medicines included in:

For each PIM found in the FHNM, the SmPC was analyzed to check the recommendations A search on the Portuguese FHNM, through the website of National Medicines and Health made for older patients. Products Authority (INFARMED, I.P.) was made.

September 2019

What was achieved?

ATC Group FHNM 181 Version 2 of the STOPP criteria

242 chemical A C 136 EU(7)-PIM List N susbtances as PIMs Alimentary Tract Cardiovascular Nervous System By at least one of the three tools. and Metabolism System 64 2019 Beers criteria 15% 27% 23% About 17% of identified PIMs were present in all of these tools.

The SmPC of 36% of the identified PIMs do not have special recommendations or precautions for older patients use!

What is next?

The identification of PIMs by hospital pharmacists, using adequate tools, is essential in order to contribute to the reduction of drug related problems in older patients. Therefore, the next step involves the implementation of clinical decision support systems that could help prescribing physicians to reduce the consumption of PIMs.

ACKNOWLEDGMENTS: Project APIMedOlder [PTDC/MED-FAR/31598/2017], supported by the operational program of competitiveness and References internationalization (POCI), in its FEDER/FNR component POCI-01-0145-FEDER-031598, and the Foundation for Science and Technology, in its state budget component (OE). Thanks are due for the financial support to Research Unit for Inland Development, Polytechnic of Guarda 1 Scott, et al. Using EMR-enabled computerized decision support systems to reduce prescribing of potentially inappropriate medications: a (UDI-IPG), and for Institute for Biomedicine – iBiMED (UID/BIM/04501/2013/UID/BIM/04501/2019 and POCI-01-0145-FEDER-035198) ) is narrative review. Ther Adv Neurol Disord 2017; 23: 153 –156. supported by the Portuguese Foundation for Science and Technology (FCT/MCTES), the co-funding by the FEDER, within the PT2020 2 Curtin D, Gallagher PF, O’Mahony D. Explicit criteria as clinical tools to minimize inappropriate medication use and its consequences. Ther Partnership Agreement and Compete 2020. Adv Neurol Disord 2017; 23: 153 –156.