Polypharmacy among Older Adults in Primary Care

Abstract

Polypharmacy among community-dwelling older adults was identified as a significant problem facing primary care providers. Medication reconciliation was identified as a necessary process to aptly identify polypharmacy. Screening Tool of Older Person’s potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to the Right Treatment (START) are evidence-based and assist primary care providers to identify potentially inappropriate prescribing (PIP) and potential prescribing omissions (PPO). A Doctor of Nursing Practice (DNP) quality improvement project was implemented in a primary care site. Clinical staff were educated on systematic medication reconciliation. Primary care providers were educated on the use of STOPP and START. Progress was evaluated using the Plan, Do, Study, Act (PDSA) Rapid Cycle of Improvement. Older adults comprised 25% of the patients seen by the providers during the data collection periods. After the education, results demonstrated there was a slight decrease in the number of charts with a comprehensive medication reconciliation performed; however, the percentage of patients experiencing polypharmacy, PIP, and PPO decreased. In conclusion, STOPP and START criteria are evidence-based, easy to use, and effective for improving prescribing quality and decreasing health care costs when used with older adults in primary care. STOPP and START criteria were recommended to be made available and referenced by all primary care providers within the larger health center. Future quality improvement initiatives should focus on implementing additional strategies to ensure that a comprehensive medication review is completed at every older adult patient encounter.