1. Prescription of 10 (+1) drugs in the Belgian geriatric wards On behalf of the College of Geriatric Medicine and experts N. Van Den Noortgate, P.Meeus, O. Dalleur, B. Boland, JC Lemper, E Dejaeger, G Lambert, K Cobbaert, S Higuet, P Hanotier, JP Baeyens Data 01/12/2015

2. QI drugs project For 2015, the College for Geriatric Medicine planned to give to the Belgian geriatric wards a feed-back on inpatient medication prescriptions The indicators were chosen on the base of STOPP-START (version 1) criteria and of the data available in the INAMI/RIZIV database The protocol was elaborated par N. van Van Den Noortgate (College) and P. Meeus (INAMI/RIZIV), and has been validated by the College  cfr. QI drugs protocol P. Meeus and his team extracted the data, which were provided to the research team (NvdN, BB, JCL, OD) and at the College’s meetings in 2015  cfr these slides: QI drugs data 2

3. Time-line Selection of inappropriate drug lists (college : 2/2015) Selection of indicators (college : 2/2015) Identification of the codes (team : 2/2015) Protocole (team : 2/2015) Methodological decisions (college 3 & 4/2015) –Incusion : all patients aged 75 +, hospitalized in G units in 2013 –Exclusion criteria patients staying at multiple units during one hospital stay patients with strong opioïds during all stay short stays (≤ 9 days) –Unit of analysis : hospital stay strict in geriatric unit Discussion of analyses (college 5, 6 & 9/2015) Feed-back to the Glem’s/Lok’s representatives (17/11/ 2015) Publication of results ( 12/2015) 3

4. Methodology: some points « potentially overuse » indicators are calculated on the last 6 days of the G stay N.B. statins and antibiotics (not in STOPP.v1) were also collected « potentially underuse » indicators are calculated on the whole stay (anticoagulant and Vitamin D) Two « global » indicators gathering: All psychotrops (benzo + antidepressants+ antipsychotics) All « potentially overuse » indicators 4

5. Sample (2013): 45.086 G pure stays, (75+, min 9 days, without opioïds) 5

6. chapters I. Potentially overuse 1.Psychotrops –Benzo –Tca –Ssri –antipsychotics 2.other potential overuses –NSAID –Ppi –Statin –Anticholinergics II. Potentially underuse (vit D – Anticoagulant) 6

7. (10) Benzo : 18 % 7

8. 8

9. (9) TCAs : 0,8 % 9

10. 10

11. (9b) SSRI : 8 % 11

12. (9b) SSRI : 8 % 12

13. (11) Antipsychotics : 7 % 13

14. (11) Antipsychotics : 7 % 14

15. Psychotrops drugs (benzo, SSRI, TCA, antipsych): 26 % 15

16. Psychotropic drugs (benzo, SSRI, TCA, antipsych): 26 % 16

17. (6) PPI : 21 % 17

18. (6) PPI : 21 % 18

19. (5) NSAIDs: 1,1 % 19

20. (5) NSAIDs: 1,1% 20

21. Statins (10 %) 21

22. Statins (10 %) 22

23. (13) Anticholinergic (with score>3): 7 % 23

24. (13) Anticholinergic (with score>3): 7 % 24

25. (13) Anticholinergic (with score>3): 7 % 25

26. chapters I. Potentially overuse 1.Psychotrops –Benzo –Tca –Ssri –antipsychotics 2.other potential overuses –NSAID –Ppi –Statin –Anticholinergics II. Potentially underuse (vit D – Anticoagulant) 26 SUMMARY: any potential overuse

27. Any potential (over)use : 41 % 27

28. Any potential (over)use : 41 % 28

29. chapters I. Potentially overuse 1.Psychotrops 2.other potential overuses II. Potentially underuse 1.vit D 2.Anticoagulant 29

30. (14) vitamin D : 50 % 30

31. (14) vitamin D : 50 % 31

32. (6) OACoag (VKA + NOAC) : 14 % (to be compared with Afib prevalence) 32

33. (6) OACoag (VKA + NOAC) : 14 % (to be compared with Afib prevalence) 33

34. Antibiotics : 57 % 34

35. Antibiotics : 57 % 35

36. 10 drugs selected by the College: USE in 45.086 geriatric patients Potentially overuse Neuro-psychotropic drugs Benzodiazepines (10.)=18 % TCAs (9a.)= 1 % SSRIs (9b.)= 7 % Antipsychotics (11.)= 7 % Any Neuro-psy drug = 26 % Other drugs NSAID (5.)= 1 % PPI (6.)= 21 % Statins= 10% Anticholinergic (13.)= 7 % Potentially underuse Vitamin D [vs. Osteoporosis] =50 % (any day during the G stay) Oral anticoagulant [vs. AFib] =14 % N.B. Antibiotics during the stay =57 % 36

37. Overview PIP at G-ward (2013) 37

38. Appendices: summary by ageclass and gender 38

39. Appendices: summary by region and province 39

40. Antwerpen 40

41. Limburg 41

42. Oost Vlanderen 42

43. Vlaams Brabant 43

44. West Vlaanderen 44

45. Brussel 45

46. Brabant Wallon, Namur, Luxembourg 46

47. Hainaut 47

48. Liege 48