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

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

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

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

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

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

(10) Benzo : 18 % 7

8

(9) TCAs : 0,8 % 9

10

(9b) SSRI : 8 % 11

(9b) SSRI : 8 % 12

(11) Antipsychotics : 7 % 13

(11) Antipsychotics : 7 % 14

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

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

(6) PPI : 21 % 17

(6) PPI : 21 % 18

(5) NSAIDs: 1,1 % 19

(5) NSAIDs: 1,1% 20

Statins (10 %) 21

Statins (10 %) 22

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

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

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

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

Any potential (over)use : 41 % 27

Any potential (over)use : 41 % 28

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

(14) vitamin D : 50 % 30

(14) vitamin D : 50 % 31

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

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

Antibiotics : 57 % 34

Antibiotics : 57 % 35

10 drugs selected by the College: USE in 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

Overview PIP at G-ward (2013) 37

Appendices: summary by ageclass and gender 38

Appendices: summary by region and province 39

Antwerpen 40

Limburg 41

Oost Vlanderen 42

Vlaams Brabant 43

West Vlaanderen 44

Brussel 45

Brabant Wallon, Namur, Luxembourg 46

Hainaut 47

Liege 48