PS-039 Essential medicines by the world health organisation and their convenience in elderly patients

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Abstract

Background

The World Health Organisation (WHO) updates the model list of essential medicines (MLEM) every 2 years. The list reflects the medicines that every healthcare system should have as a minimal requirement. On a global scale, elderly patients with chronic diseases are prioritised by healthcare systems, requiring a complex and multidisciplinary approach. Explicit criteria guides have been produced to adapt prescriptions to elderly patients, detecting potentially inappropriate medications (PIM) and potential prescribing omissions (PPO).

Purpose

To evaluate the adequacy of the WHO MLEM with Beers, Priscus and Screening Tool of Older Person’s Prescriptions-Screening Tool to Alert doctors to Right Prescriptions (STOPP-START) criteria.

Material and methods

This was an observational study comparing Beers 2015, Priscus 2010 and STOPP-START 2014 criteria with the MLEM 19th edition, dismissing no chronic/no elderly disease drugs: anaesthetics, palliative care drugs, antidotes, anti-infectives (except for antiretrovirals, anti-hepatitis B and nitrofurantoin), cytotoxics, blood products of human origin and plasma substitutes, metildopa, thrombolytic and dermatological medicines, diagnostic agents, ovulation inducers, progestogens, immunologicals, vaccines, muscle relaxants, ophthalmic preparations (except miotics, glaucoma medicines and bebacizumab), oxytocis/antioxytocs, solutions correcting water, electrolyte and acid–base disturbances, ear, nose, throat, neonatal and juvenile joint diseases medicines.

Results

MLEN has 409 medicines; 140 are considered chronic disease drugs. According to Beers criteria, MLEM has 16/140 (11.43%) absolute PIMs (with 133 drugs), 29/140 (20.71%) that may exacerbate an illness/syndrome (among complex drugs list), 18/140 (12.86%) that must be used with caution (Beers includes dabigatran, prasugrel, mirtazapin, oxcarbazepin and vasodilatation drugs that do not appear in MLEM) and 3/140 (2.14%) to avoid/adjust with liver/renal impairment (of 20 drugs). According to Priscus criteria (with 83 PIMs), MLEM has 11/140 (7.86%). According to STOPP-START criteria, MLEM has 44/140 (27.50%) PIMs and 31/140 (22.14%) PPOs. MLEM does not includes some PIMs (ticlopidine, acetylcholinesterase inhibitors, first generation antihistamines, prochlorperazine, iron, theophylline, COX-2 inhibitors, α-1 receptor blockers, thiazolidinediones, z-drugs) or PPOs (acetylcholinesterase inhibitors, dopaminergic agonist, fibre supplements, anti-resorptive and anabolic therapy for bones, angiotensin receptor blocker, α-1 receptor blockers, 5-α reductase inhibitors, topical and pessary vaginal oestrogen).

Conclusion

Explicit criteria guides have different potentiality to detect PIMs. MLEM can avoid PIMs. However, according to STOPP-START criteria, MLEM has not enough PPOs.

References and/or acknowledgements

Thanks to Iris Milán Maillo.

References and/or acknowledgements

No conflict of interest

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