Background
Methods
STOPP criteria | |
---|---|
A. Cardiovascular system | |
1 | Digoxin at a long-term dose >125 mg/d with impaired renal function |
2 | Loop diuretic as first-line monotherapy for hypertension or for dependent ankle edema only |
3 | Thiazide diuretic with a history of gout |
4 | Noncardioselective b-blocker with chronic obstructive pulmonary disease |
5 | b-blocker in combination with verapamil |
6 | Use of diltiazem or verapamil with New York Heart Association class 3 or 4 heart failure |
7 | Calcium-channel blockers with chronic constipation |
8 | Use of aspirin and warfarin in combination without histamine H2 receptor antagonist |
(except cimetidine) or proton pump inhibitor | |
9 | Dipyridamole as monotherapy for cardiovascular secondary prevention |
10 | Aspirin with no history of coronary, cerebral or peripheral vascular symptoms |
or occlusive arterial event or with a past history of peptic ulcer disease | |
without histamine H2 receptor antagonist or proton pumpinhibitor or at dose >150 mg/d | |
or to treat dizziness not clearly attributed to cerebrovascular disease | |
11 | Warfarin for first, uncomplicated deep venous thrombosis for longer than 6-month duration |
or for first, uncomplicated pulmonary embolus for longer than 12-month duration | |
12 | Aspirin, clopidogrel, dipyridamole, or warfarin with concurrent bleeding disorder |
B. CNS and psychotropic drugs | |
1 | Tricyclic antidepressants with dementia or with glaucoma or with cardiac conductive abnormalities |
or with constipation or with prostatism or prior history of urinary retention or with an opiate | |
or calcium-channel blocker | |
2 | Long-term (>3 month) use of long-acting benzodiazepines, and with long-acting metabolites |
3 | Long-term (>1 month) neuroleptics as long-term hypnotics or in those with parkinsonism |
4 | Phenothiazines in patients with epilepsy |
5 | Anticholinergics to treat extrapyramidal side effects of neuroleptic medications |
6 | Selective serotonin reuptake inhibitors with a history of clinically significant hyponatremia |
(noniatrogenic hyponatremia <130 mmol/L within the previous 2 months) | |
7 | Prolonged use (>1 week) of first-generation antihistamines |
C. Gastrointestinal system | |
1 | Diphenoxylate, loperamide or codeine phosphate for treatment of diarrhea of unknown cause |
or severe infective gastroenteritis | |
2 | Prochlorperazine or metoclopramide with parkinsonism |
3 | Proton pump inhibitors for peptic ulcer disease at full therapeutic dosage for >8 weeks |
4 | Anticholinergic antispasmodic drugs with chronic constipation |
D. Respiratory system | |
1 | Theophylline as monotherapy for chronic obstructive pulmonary disease |
2 | Systemic corticosteroids instead of inhaled corticosteroids for maintenance therapy |
in moderate-to-severe chronic obstructive pulmonary disease | |
3 | Nebulized ipratropium with glaucoma |
E. Musculoskeletal system | |
1 | NSAID with history of peptic ulcer disease or gastrointestinal bleeding, unless with concurrent |
histamine H2 receptor antagonist, proton pump inhibitor, or misoprostol | |
2 | NSAID with moderate-to-severe hypertension or with heart failure |
3 | Long-term use of NSAID (>3 months) for relief of mild joint pain in osteoarthritis |
4 | Warfarin and NSAID together |
5 | NSAID with chronic renal failure |
6 | Long-term corticosteroids (>3 months) as monotherapy for rheumatoid arthritis |
or osteoarthritis | |
7 | Long-term NSAID or colchicine for chronic treatment of gout where there is |
no contraindication to allopurinol | |
F. Urogenital system | |
1 | Bladder antimuscarinic drugs with dementia or with chronic glaucoma |
or with chronic constipation or with chronic prostatism | |
2 | a-blockers in males with frequent incontinence |
3 | a-blockers with long-term urinary catheter in situ (>2 months) |
G. Endocrine system | |
1 | Glibenclamide or chlorpropamide with type 2 diabetes mellitus |
2 | b-blockers in those with diabetes mellitus and frequent hypoglycemic episodes |
3 | Estrogens with a history of breast cancer or venous thromboembolism |
4 | Estrogens without progestogen in patients with intact uterus |
H. Drugs that adversely affect those prone to falls (at least 1 fall in past 3 months) | |
1 | Benzodiazepines |
2 | Neuroleptic drugs |
3 | First-generation antihistamines |
4 | Vasodilator drugs known to cause hypotension in those with persistent postural hypotension |
5 | Long-term opiates in those with recurrent falls |
I. Analgesic drugs | |
1 | Use of long-term powerful opiates as first-line therapy for mild-to-moderate pain |
2 | Regular opiates for more than 2 weeks in those with chronic constipation |
without concurrent use of laxatives | |
3 | Long-term opiates in those with dementia unless indicated for palliative care |
or management of moderate-to-severe chronic pain syndrome | |
J. Duplicate drug classes | |
1 | Any regular duplicate drug class prescription, such as two concurrent opiates, NSAIDs, |
serotonin-specific reuptake inhibitors, loop diuretics, and ACE inhibitors |
Statistical methods
Results
Demography
Before propensity score weighted adjustment | After propensity score weighted adjustment | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
All patients | Using nurse home visit programs | Using pharmacist home visit programs | Using nurse home visit programs (weighted by PS for nurse) | Using pharmacist home visit programs (weighted by PS for pharmacist) | |||||||||
(n = 430);n (%) | Patients who used nurse home visit programs (n = 203); n (%) | Patients who did not used nurse home visit programs (n = 227); n (%) | P-value | Patients who used pharmacist home visit programs (n = 182); n (%) | Patients who did not used pharmacist home visit programs (n = 248); n (%) | P-value | Patients who used nurse home visit programs (%) | Patients who did not used nurse home visit programs (%) | P-value | Patients who used pharmacist home visit programs (%) | Patients who did not used pharmacist home visit programs (%) | P-value | |
Gender | 0.013 | 0.073 | 0.924 | 0.950 | |||||||||
Male | 154 (35.8%) | 85 (41.9%) | 69 (30.4%) | 74 (40.7%) | 80 (32.3%) | (34.3%) | (34.0%) | (35.6%) | (35.4%) | ||||
Female | 276 (64.2%) | 118 (58.1%) | 158 (69.6%) | 108 (59.3%) | 168 (67.7%) | (65.7%) | (66.0%) | (64.4%) | (64.6%) | ||||
Mean age (years ± standard deviation) | 85.0 ± 8.3 | 84.3 ± 8.6 | 85.7 ± 8.0 | 0.07 | 84.7 ± 8.1 | 85.2 ± 8.4 | 0.523 | 85.5 ± 8.5 | 84.9 ± 8.1 | 0.298 | 85.3 ± 8.3 | 85.0 ± 8.2 | 0.575 |
Age (years) | 0.004 | 0.177 | 0.909 | 0.976 | |||||||||
65-74 | 55 (12.8%) | 29 (14.3%) | 26 (11.5%) | 22 (12.1%) | 33 (13.3%) | (12.0%) | (12.1%) | (12.9%) | (12.4%) | ||||
75-84 | 126 (29.3%) | 73 (36.0%) | 53 (23.3%) | 62 (34.1%) | 64 (25.8%) | (30.6%) | (31.9%) | (28.8%) | (29.0%) | ||||
≥85 | 249 (57.9%) | 101 (49.8%) | 148 (65.2%) | 98 (53.8%) | 151 (60.9%) | (56.0%) | (56.0%) | (58.3%) | (58.5%) | ||||
Independent ambulation | 199 (46.3%) | 71 (35.0%) | 128 (56.4%) | <0.001 | 91 (50.0%) | 108 (43.5%) | 0.185 | (45.3%) | (45.6%) | 0.925 | (45.9%) | (46.1%) | 0.934 |
Independent drug overview | 115 (26.7%) | 44 (21.7%) | 71 (31.3%) | 0.025 | 54 (29.7%) | 61 (24.6%) | 0.24 | (22.8%) | (24.8%) | 0.482 | (27.4%) | (26.7%) | 0.812 |
Living with family | 381 (88.6%) | 190 (93.6%) | 191 (84.1%) | 0.002 | 155 (85.2%) | 226 (91.1%) | 0.054 | (87.3%) | (88.4%) | 0.626 | (88.7%) | (88.1%) | 0.774 |
Using home visit programs by nurse | 203 (47.2%) | - | - | - | 78 (42.9%) | 125 (50.4%) | 0.121 | - | - | - | (47.7%) | (47.1%) | 0.855 |
Using home visit programs by pharmacist | 182 (42.3%) | 78 (38.4%) | 104 (45.8%) | 0.121 | - | - | - | (41.5%) | (42.2%) | 0.844 | - | - | - |
Underlying medical conditions | |||||||||||||
Constipation | 243 (56.5%) | 113 (55.7%) | 130 (57.3%) | 0.738 | 115 (63.2%) | 128 (51.6%) | 0.017 | 59.6% | 59.4% | 0.955 | 55.4% | 56.2% | 0.818 |
Hypertension | 228 (53.0%) | 84 (41.4%) | 144 (63.4%) | <0.001 | 101 (55.5%) | 127 (51.2%) | 0.379 | 49.5% | 51.8% | 0.513 | 52.8% | 53.2% | 0.907 |
Dementia | 218 (50.7%) | 87 (42.9%) | 131 (57.7%) | 0.002 | 89 (48.9%) | 129 (52.0%) | 0.523 | 52.5% | 54.2% | 0.601 | 50.9% | 51.5% | 0.860 |
Cerebral infarction/transient ischemic attack | 104 (24.2%) | 45 (22.2%) | 59 (26.0%) | 0.355 | 44 (24.2%) | 60 (24.2%) | 0.997 | 26.8% | 24.5% | 0.456 | 24.7% | 25.1% | 0.906 |
Osteoporosis | 95 (22.1%) | 38 (18.7%) | 57 (25.1%) | 0.111 | 47 (25.8%) | 48 (19.4%) | 0.11 | 26.0% | 22.9% | 0.299 | 22.1% | 22.5% | 0.898 |
Diabetes mellitus | 82 (19.1%) | 33 (16.3%) | 49 (21.6%) | 0.16 | 43 (23.6%) | 39 (15.7%) | 0.039 | 20.2% | 19.1% | 0.691 | 19.2% | 19.7% | 0.852 |
Coronary artery disease | 59 (13.7%) | 27 (13.3%) | 32 (14.1%) | 0.811 | 28 (15.4%) | 31 (12.5%) | 0.39 | 13.3% | 15.3% | 0.410 | 11.8% | 13.1% | 0.544 |
Atrial fibrillation | 55 (12.8)% | 29 (14.3%) | 26 (11.5%) | 0.38 | 27 (14.8%) | 28 (11.3%) | 0.277 | 12.9% | 12.3% | 0.776 | 12.7% | 12.2% | 0.816 |
Dyslipidemia | 51 (11.9%) | 17 (8.4%) | 34 (15.0%) | 0.034 | 27 (14.8%) | 24 (9.7%) | 0.102 | 9.9% | 11.8% | 0.358 | 12.2% | 12.6% | 0.847 |
Benign prostatic hypertrophy | 47 (10.9%) | 24 (11.8%) | 23 (10.1%) | 0.575 | 22 (12.1%) | 25 (10.1%) | 0.51 | 10.1% | 11.6% | 0.485 | 9.9% | 10.8% | 0.685 |
Progressive malignancy | 34 (7.9%) | 23 (11.3%) | 11 (4.8%) | 0.013 | 14 (7.7%) | 20 (8.1%) | 0.888 | 7.5% | 7.1% | 0.807 | 7.2% | 7.7% | 0.751 |
Hyperuricemia/gout | 32 (7.4%) | 9 (4.4%) | 23 (10.1%) | 0.025 | 19 (10.4%) | 13 (5.2%) | 0.042 | 9.2% | 7.8% | 0.473 | 8.1% | 8.2% | 0.951 |
Heart failure | 30 (7.0%) | 17 (8.4%) | 13 (5.7%) | 0.282 | 14 (7.7%) | 16 (6.5%) | 0.618 | 5.0% | 7.3% | 0.163 | 6.2% | 5.9% | 0.815 |
Parkinson's Disease/Parkinson's syndrome | 28 (6.5%) | 14 (6.9%) | 14 (6.2%) | 0.76 | 13 (7.1%) | 15 (6.0%) | 0.649 | 7.5% | 7.8% | 0.866 | 6.2% | 6.6% | 0.840 |
Chronic obstructive pulmonary disease | 27 (6.3%) | 19 (9.4%) | 8 (3.5%) | 0.013 | 17 (9.3%) | 10 (4.0%) | 0.025 | 5.9% | 3.8% | 0.156 | 6.0% | 5.2% | 0.592 |
Peripheral artery occlusive disease | 27 (6.3%) | 7 (3.4%) | 20 (8.8%) | 0.022 | 16 (8.8%) | 11 (4.4%) | 0.066 | 4.0% | 5.7% | 0.253 | 6.0% | 5.6% | 0.816 |
Cerebral/subarachnoid hemorrhage | 26 (6.0%) | 11 (5.4%) | 15 (6.6%) | 0.606 | 17 (9.3%) | 9 (3.6%) | 0.014 | 5.2% | 6.4% | 0.452 | 6.0% | 6.3% | 0.846 |
Osteoarthritis | 21 (4.9%) | 6 (3.0%) | 15 (6.6%) | 0.079 | 9 (4.9%) | 12 (4.8%) | 0.96 | 5.6% | 5.0% | 0.658 | 5.1% | 4.9% | 0.919 |
Number of prescriptions (mean ± standard deviation) | 6.1 ± 3.0 | 6.3 ± 3.0 | 5.8 ± 3.0 | 0.065 | 6.6 ± 3.1 | 5.6 ± 2.8 | <0.001 | 6.2 ± 3.0 | 6.0 ± 3.1 | 0.427 | 5.9 ± 3.0 | 6.0 ± 3.0 | 0.879 |
Specific prescriptions of PIMs
Prescription | (n = 430); n (%) | |
---|---|---|
1 | Calcium-channel blockers with chronic constipation | 74 (17.2%) |
2 | Long-term use of NSAID (>3 months) for relief of mild joint pain in osteoarthritis | 16 (3.7%) |
3 | Long-term (>1 month) use of long-acting benzodiazepines, and with long-acting metabolites | 15 (3.5%) |
4 | NSAID with moderate-to-severe hypertension or with heart failure | 14 (3.3%) |
5 | Loop diuretic as first-line monotherapy for hypertension or for dependent ankle edema only | 13 (3.0%) |
6 | Any regular duplicate drug class prescription, such as two concurrent opiates, NSAIDs, serotonin-specific reuptake inhibitors, loop diuretics, and ACE inhibitors | 11 (2.6%) |
7 | Benzodiazepines for patients who have had at least 1 fall in the past 3 months | 10 (2.3%) |
The cost of PIMs after propensity score weighted adjustment
(Total cost of PIMs per patient per month in USD) | ||||||
---|---|---|---|---|---|---|
Using pharmacist home visit programs (weighted by PS for pharmacist) | ||||||
n | Patients who used pharmacist home visit programs (n = 182) | Patients who did not use pharmacist home visit programs (n = 248) | Difference between two groups | 95% CI | P-value | |
All patients† | 430 | 7.2 ± 14.5 | 5.5 ± 11.5 | −1.7 | −3.5 - 0.07 | 0.06 |
Patients who used nurse home visit programs† | 203 | 5.5 ± 13.9 | 2.5 ± 6.0 | −2.9 | −5.0 - -0.83 | 0.006 |
Patients who did not use nurse home visit programs† | 227 | 8.7 ± 15.7 | 8.1 ± 14.2 | −0.66 | −3.4 - 2.1 | 0.64 |
(Total cost of PIMs per patient per month in USD) | ||||||
---|---|---|---|---|---|---|
Using nurse home visit programs (weighted by PS for nurse) | ||||||
n | Patients who used nurse home visit programs (n = 203) | Patients who did not use nurse home visit programs (n = 227) | Difference between two groups | 95% CI | P-value | |
All patients† | 430 | 5.9 ± 13.1 | 7.1 ± 13.9 | 1.2 | −0.63 - 3.0 | 0.199 |
Patients who used pharmacist home visit programs† | 182 | 9.1 ± 17.8 | 8.8 ± 15.3 | −0.22 | −3.7 - 3.2 | 0.898 |
Patients who did not use pharmacist home visit programs† | 248 | 3.6 ± 7.7 | 5.8 ± 12.7 | 2.2 | 0.31 - 4.0 | 0.022 |