Application of the STOPP criteria in hospitalised elderly patients to detect and optimise inappropriate psychopharmaceutical prescriptions

BackgroundPsychotropic drugs are frequently used in the elderly population, but their inappropriate prescription can cause numerous adverse effects and interactions.ObjectiveTo evaluate the impact of a multidisciplinary intervention to detect and optimise inappropriate prescriptions of psychotropic drugs in patients aged over 75years in a hospital setting.Design, setting, subjects and methodsA prospective study which included every patient aged over 75years admitted to the Consorcio Hospital General in Valencia, Spain,and who had been prescribed psychotropic drugs inappropriately, carried out over 1 year. The intervention was to detect inappropriate prescriptions of psychotropic drugs using the STOPP criteria, treatment optimisation by a team of psychiatrists, readjustment of the electronic prescription register, and communication to the primary care physician. The impact of the intervention was assessed by measuring the persistence of the changes made 3 months after discharge and by quarterly assessment of inappropriate prescriptions.ResultsOf 4571 admissions, 378 inappropriate prescriptions were detected in 346 patients. The drugs most frequently used were long half-life benzodiazepines (70%), which were substituted in 62% of the cases, withdrawn in 32%, and maintained in 6%. At 3 months follow-up, the changes had been maintained by the patients' primary care physician in 67%. Evaluation of the prescriptions during the subsequent quarters of the year showed a significant decrease in the inappropriate prescriptions, especially benzodiazepines.ConclusionsCoordinated intervention by pharmacologists and psychiatrists in hospital settings, and communication between these professionals and primary care teams, can reduce psychotropic drugs inappropriately prescribed to the elderly.