69An Exploration of Modification of Potentially Inappropriate Prescribing and Potential Prescribing Omissions Following Fall-Related Hospitalisations

Abstract

Background: Fall-related hospitalisations should trigger medication review. The STOPP/START 2 criteria recommend stopping specific sedatives and vasodilators and starting Vitamin D among those experiencing falls. This study aimed to examine the prevalence of these indicators of potentially inappropriate prescribing in older people with fall-admissions and to explore post-admission prescription patterns. Methods: Prescribing and hospitalisation data for patients aged >65 were collected from 44 Irish general practices using patient-management software. The Irish College of General Practitioners granted ethical approval. Hospital admissions for falls, fractures and syncope were selected. The prevalence of prescriptions for benzodiazepines, neuroleptics, 'z-drugs', vasodilators and Vitamin D were estimated from GP records in the 12 months pre-admission and using hospital discharge and GP records in the 12 months post-admission. Pre/post admission prevalence was compared with McNemar's test. Results: A total of 1,047 patients with potentially fall-related admissions were identified between 2012 and 2016. 944 individuals (67% female), with prescription data available before and after hospitalisation, were included in the analysis. Average age at admission was 81.2 years (SD = 8.6). The admitting diagnosis for 45% of individuals (n= 421) was fracture, for 27% (n = 257) was a fall without fracture and for 28% (n = 266) was syncope. Median length of stay was 7 days (IQR 2-17). The proportion of those prescribed Vitamin D significantly increased post-hospitalisation (n = 347 (37%) before, n = 485 (51%) after, p < 0.01). The proportion with benzodiazepine, neuroleptic or z-drug prescriptions also significantly increased (n = 373, 40% before, n = 425, 45% after, p < 0.01). Over half were prescribed vasodilators at both time periods (n = 505, (54%) before, n = 510 (54%) after, p = 0.7). Conclusion: Preliminary results from univariable analysis suggest an increase in Vitamin D prescription after a fall-related admission but other improvements in prescribing according to the STOPP criteria are not evident. Further multivariable analysis is planned to identify factors associated with prescription modification in this cohort.