Effect of Development of an Electronic Prescription Screening Tools with Modified STOPP/START Criteria on Prescription Appropriation in Elderly Patients in Outpatient Department, Phatthalung Hospital

Abstract

Background: Thailand is transitioning into an aged society, and many elderly individuals suffer from multiple chronic diseases and use several medications, which increases the risk of inappropriate prescriptions. The STOPP/START Criteria are used to screen medication prescriptions for elderly patients. To enhance the efficiency of screening, an electronic prescription screening program based on the STOPP/START criteria was developed to assist pharmacists in identifying inappropriate prescriptions.

Objective: To study the effect of an electronic prescription screening program on reducing inappropriate medication prescriptions for elderly outpatients (≥65 years) at Phatthalung Hospital.

Method: A quasi-experimental design was used in this study. The sample included 12,000 elderly patients with at least one chronic disease and who were prescribed at least one medication. The sample was divided into a control group of 6,000 patients, with data collected between October 1, 2023, and November 30, 2023, and an experimental group of 6,000 patients, with data collected between August 1, 2024, and September 30, 2024. Data were collected from electronic medical records and analyzed using descriptive and inferential statistics, including the Mann-Whitney U test, chi-square test, and Fisher's exact test.

Results: The control group consisted of 42.55% males and 57.45% females, while the experimental group had 43.78% males and 56.22% females. The majority of patients in both groups were aged between 65 and 69 years. The median number of medications prescribed was four. Common chronic conditions included hyperlipidemia, followed by hypertension, diabetes, and chronic kidney disease. After the development of the electronic prescription screening program, the overall inappropriate prescription rate decreased from 21.32% to 16.00% (p-value<0.001). Specifically, potentially inappropriate medications (PIMs) decreased from 7.87% to 5.85% (p-value<0.001), and potential prescribing omissions (PPOs) decreased from 15.93% to 11.32% (p-value<0.001). The proportion of inappropriate prescribing based on the six STOPP criteria and five START criteria also significantly decreased.

Conclusion: The developed electronic prescription screening program significantly reduced inappropriate prescribing in elderly patients, ensuring that they received medications suited to their conditions and diseases. This innovation effectively improved treatment quality and medication safety for elderly patients.