Modern problems of pharmacotherapy of patients elderly and senile age at the PHC level in Kazakhstan: STOPP/ START criteria

Aim: To identify modern problems of pharmacotherapy of elderly and later life patients at the PHC level in Kazakhstan using the STOPP / START criteria.
Methods: A prospective descriptive study was carried out at the primary care level, in 5 clinics in Kazakhstan. The study involved 205 patients over 65 years old who received regular outpatient treatment for chronic diseases. Patients’ current diagnoses and prescription medicines were reviewed and the STOPP and START tools applied.
Result: The frequency of potentially inappropriate prescriptions was 56% and is significant. There was a high frequency of prescribing centrally acting antihypertensive drugs (21%), long-acting sulfonylureas (16.5%), prescribing NSAIDs without prophylactic PPIs (20%) and COX-2 drugs for CVD (7%) in persons over 65 years of age at the level PHC. The frequency of Missed appointments at the PHC level was 23%. Most often, statins were not prescribed with a documented history of coronary, cerebral disease (27%), and beta-blockers in coronary artery disease (6%), and ACE inhibitors in systolic CHF and angina pectoris (5%), which causes a high risk of cardiovascular complications in elderly people.
Conclusion: On the basis of the study, problems have been identified that indicate a high risk of developing ADR in persons over 65 at the outpatient level, which require the introduction of modern technologies and tools to identify PIP and prevent polypharmacy.

1. Al’-Radzhavi Ali. Rasprostranjonnost’ naznachenij potencial’no ne rekomendovannyh lekarstvennyh sredstv v praktike vedenija pacientov pozhilogo i starcheskogo vozrasta [Tekst]/ Al’- Radzhavi Ali, S.K. Zyrjanov, E.A. Ushkalova, O.I. Butranova, A.P. Pereverzev // Kachestvennaja klinicheskaja praktika. - 2019. - №1. – S.66-78

2. Panova, E.A. Polipragmazija u ambulatornyh pacientov pozhilogo vozrasta [Tekst]/ E.A. Panova, V.A.Serov, A.M. Shutov, N.N. Bakumceva, M.Ju. Kuzovenkova // Ul’janovskij mediko-biologicheskij zhurnal. - 2019. - №2. –S.22-28

3. Spravochnaja sistema Medelement. Jelektronnaja baza klinicheskih protokolov MZ.RK. [Jelektronnyj resurs]/ RCRZ (Respublikanskij centr razvitija zdravoohranenija MZ RK).Protokol MZ RK «Hronicheskaja serdechnaja nedostatochnost’» ot «10» sentjabrja 2020 goda Protokol №115 https://diseases.medelement.com

4. Protokol MZ RK «Arterial’naja gipertenzija» ot «3» oktjabrja 2019 goda Protokol №74 https://diseases.medelement.com

5. Spravochnaja sistema Medelement. Jelektronnaja baza klinicheskih protokolov MZ.RK. [Jelektronnyj resurs]/ RCRZ (Respublikanskij centr razvitija zdravoohranenija MZ RK).Protokol MZ RK «IBS. Stabil’naja stenokardija naprjazhenija» ot «30» nojabrja 2015. - №18 https://diseases.medelement.com https://login.medelement.com/

6. Spravochnaja sistema Medelement. Jelektronnaja baza klinicheskih protokolov MZ.RK. [Jelektronnyj resurs]/ RCRZ (Respublikanskij centr razvitija zdravoohranenija MZ RK).Protokol MZ RK «Cerebral’nyj ateroskleroz»

7. Spravochnaja sistema Medelement. Jelektronnaja baza klinicheskih protokolov MZ.RK. [Jelektronnyj resurs]/ RCRZ (Respublikanskij centr razvitija zdravoohranenija MZ RK).Protokol MZ RK «Ateroskleroz sosudov konechnostej»

8. Beers, M.H. Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. [Tekst]/ M.H. Beers//Arch Intern Med. - 1997. - №157(14). – P.1531-1536. PMID: 9236554

9. Bushardt, R.L. Polypharmacy: misleading, but manageable. [Tekst]/ R.L Bushardt., E.B.Massey, T.W Simpson., J.C.Ariail, K.N.//Simpson Clin Interv Aging. – 2008 - №3(2) – P.383-389. doi:10.2147/cia.s2468

10. Cohn, J.N. MOXCON Investigators. Adverse mortality effect of central sympathetic inhibition with sustained-release moxonidine in patients with heart failure (MOXCON) [Tekst]/ J.N. Cohn, M.A. Pfeffer, J. Rouleau, N. Sharpe, K. Swedberg, M. Straub, C. Wiltse, T.J. Wright//Eur J Heart Fail. – 2003. - №5(5). – P.659-67. DOI: 10.1016 / s1388-9842 (03) 00163-6

11. Coming of Age: Infographic on Global Population Trends — IMF F&D [Internet resurs] https://www.imf.org/Publications/fandd/issues/2020/03/infographic-global-populationtrends-picture

12. Corsonello, S. Age-Related Pharmacokinetic and Pharmacodynamic Changes and Related Risk of Adverse Drug Reactions. [Tekst]/ S. Corsonello, C. Pedone, R. AntonelliIncalzi// Current Medicinal Chemistry – 2010. - №17. – P.571. https://doi.org/10.2174/092986710790416326

13. Hill-Taylor, B. Application of the STOPP/ START criteria: a systematic review of the prevalence of potentially inappropriate prescribing in older adults, and evidence of clinical, humanistic and economic impact. [Tekst]/ B. Hill-Taylor, I. Sketris, J. Hayden, S. Byrne, D. O’Sullivan, R.Christie// ClinPharmTher. – 2013. - №38. – P.360–372. doi: 10.1111/jcpt.12059. DOI:10.1111/jcpt.1205

14. Magro, L. Epidemiology and characteristics of adverse drug reactions caused by drug-drug interactions. [Tekst]/ L. Magro, U. Moretti, R.Leone // Expert Opin Drug Saf. – 2012. - №11(1) – P.83-94. https://doi.org/10.1517/14740338.2012.631910

15. O’Mahony, D. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2 [published correction appears in Age Ageing. 2018 May 1;47(3):489]. [Tekst]/ D. O’Mahony, D. O’Sullivan, S. Byrne, M.N. O’Connor, C. Ryan, P.Gallagher //Age Ageing. - 2015. - № 44(2). – P.213–218. doi:10.1093/ageing/afu145

16. Perl, S. Effects of Glimepiride versus Saxagliptin on β-Cell Function and Hypoglycemia: A Post Hoc Analysis in Older Patients with Type 2 Diabetes Inadequately Controlled with Metformin. [Tekst]/ S. Perl, W. Cook, C. Wei, P. Ohman, B. Hirshberg// Clin Ther. – 2016. №38(12). – P.2578-2588. PMID: 27823868

17. Swedberg K, The effects of moxonidine SR, an imidazoline agonist, on plasma norepinephrine in patients with chronic heart failure. [Tekst]/ K. Swedberg, M. Bristow, J.N. Cohn// Circulation.- 2002. - №10. – P.1797 – 1803.

18. Taché, S. V. Prevalence of Adverse Drug Events in Ambulatory Care: A Systematic Review. [Tekst]/ S.V. Taché, A.Sönnichsen, D. M. Ashcroft, //Annals of Pharmacotherapy. – 2011. - №45(7–8). –P .977–989. https://doi.org/10.1345/aph.1P627

19. Taché, S. Prevalence of Adverse Drug Events in Ambulatory Care: A Systematic Review [Tekst]/ S. V. Taché, A.Sönnichsen, D. M. Ashcroft// Annals of Pharmacotherapy - 2011. -№45. (7–8) - P. 977–989. https://doi.org/10.1345/aph.1P627

20. Thomas, R. A systematic review of studies of the STOPP/START 2015 and American Geriatric Society Beers 2015 criteria. [Tekst]/ R.Thomas, B. Thomas// Current Aging Science. – 2019. - №12. –P.349-357

21. Tommelein, Potentially inappropriate prescribing in community-dwelling older people across Europe: A systematic literature review. [Tekst]/ Tommelein, Eline&Mehuys, Els&Petrovic, Mirko& Somers, Annemie& Colin, Pieter &Boussery, Koen//European journal of clinical pharmacology. – 2015.