Evaluación de la actualización de los criterios STOPP-START en atención primaria

espanolIntroduccion El objetivo de este trabajo es averiguar la prevalencia de prescripcion potencialmente inapropiada (PPI) en poblacion mayor de 64 anos en Aviles, Asturias. Material y metodos Estudio descriptivo transversal multicentrico en seis centros de salud. Se selecciono una muestra de 400 personas obtenida por muestreo aleatorio proporcional a la poblacion adscrita a cada centro de salud. Se revisaron las historias clinicas informatizadas y se aplicaron los criterios STOPP-START (version 2014 con 114 items) para evaluar la PPI. Resultados Se estudiaron 378 (95,5%) pacientes, con una media de edad de 75,4 anos (DE: 7,4) y una proporcion de 57,7% mujeres. El 94,2% (IC95%:91,7-96,7) presentaban alguna PPI. Atendiendo solo a los criterios STOPP un 52,4% (IC95%:47,2-57,6) de pacientes presentaba al menos un incumplimiento y en los START un 90,5% (IC95%:87,4-93,6) que se reducia a 40,5% (IC95%: 36,4-45,6) si se eliminaban los criterios referidos a vacunaciones. Entre los criterios STOPP, la PPI mas frecuente fue la toma de benzodiacepinas seguido del uso de medicamentos sin indicacion basada en la evidencia; entre los START fueron la vacunacion antineumococica y la ausencia de la toma de suplementos de vitamina D y calcio en osteoporosis. Conclusiones Nivel elevado de PPI, muy superior al resultante en la version previa especialmente para los criterios START. Existe un elevado nivel de PPI en relacion con el uso de benzodicepinas y el empleo de medicamentos sin evidencia clinica. Los criterios STOPP-START son utiles en atencion primaria para evaluar la PPI. EnglishIntroduction The aim of this study is to determine the rate of potentially inappropriate prescriptions (PIP) in people older than 64 years of age in Aviles, Asturias, Spain. Materials and methods A descriptive cross-sectional study was conducted in six Health Care Centres. A sample of 400 people was selected, obtained by a random sampling proportional to the population registered in each Health Centre. A review was made of the computerised clinical records, and the STOPP-START (version 2014 with 114 items) criteria were applied to evaluate the PIP. Results The study contained 378 (95.5%) patients with a mean age of 75.4 (SD: 7.4) and of which 57.7% were women. Almost all (94.2%: 95% CI; 91.7-96.7) met some PIP criteria. Taking only the STOPP criteria into consideration, 52.4% (95%CI: 47.2-57.6) met at least one breach, and in the START criteria a 90.5% (95%CI; 87.4-93.6), which was reduced to 40.5% (95%CI; 36.4-45.6) if criteria on vaccination were removed. In the STOPP criteria, the most frequent PIP was taking benzodiazepines followed by the use of medication without indications based on the evidence; in the START, the criteria was the anti-pneumococcus vaccination, and the lack of taking vitamin D supplements and calcium in osteoporosis. Conclusions There were high levels of PIP, very superior to the previous version, especially for the START criteria. There is a high level of PIP related to the use of benzodiazepines and the use of medication without any clinic evidence. The STOPP-START criteria are useful in Primary Care to assess the PIP.