STOPP (Screening Tool of Older Persons’ Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation
ABSTRACT Older people experience more concurrent illnesses, are prescribed more medications and suffer more adverse drug events than younger people. Many drugs predispose older people to adverse events such as falls and cognitive impairment, thus increasing morbidity and health resource utilization. At the same time, older people are often denied potentially beneficial, clinically indicated medications without a valid reason. We aimed to validate a new screening tool of older persons' prescriptions incorporating criteria for potentially inappropriate drugs called STOPP (Screening Tool of Older Persons' Prescriptions) and criteria for potentially appropriate, indicated drugs called START (Screening Tool to Alert doctors to Right, i.e. appropriate, indicated Treatment).
A Delphi consensus technique was used to establish the content validity of STOPP/START. An 18-member expert panel from academic centers in Ireland and the United Kingdom completed two rounds of the Delphi process by mail survey. Inter-rater reliability was assessed by determining the kappa-statistic for measure of agreement on 100 data-sets.
STOPP is comprised of 65 clinically significant criteria for potentially inappropriate prescribing in older people. Each criterion is accompanied by a concise explanation as to why the prescribing practice is potentially inappropriate. START consists of 22 evidence-based prescribing indicators for commonly encountered diseases in older people. Inter-rater reliability is favorable with a kappa-coefficient of 0.75 for STOPP and 0.68 for START.
STOPP/START is a valid, reliable and comprehensive screening tool that enables the prescribing physician to appraise an older patient's prescription drugs in the context of his/her concurrent diagnoses.
- SourceAvailable from: Daria Putignano
- "Per ciascun farmaco sono state riportate anche le alternative terapeutiche. Il metodo STOPP and START , elaborato da un team di 18 esperti britannici, propone due tipologie di criteri: i farmaci da non prescrivere nel paziente anziano (criteri STOPP: Screening Tool of Older Person's Prescriptions) e i farmaci appropriati per lo stesso paziente in determinate condizioni patologiche (criteri START: Screening Tool to Alert doctors to Right Treatment). I criteri STOPP constano di una lista comprensiva di 65 indicatori di farmaci potenzialmente inappropriati suddivisi in 10 aree clinicoterapeutiche , di cui 7 si riferiscono a diversi sistemi anatomici (ad esempio sistema cardiovascolare o muscolo-scheletrico), 1 ad una classe di farmaci (farmaci analgesici ), 1 a farmaci che possono causare cadute e 1 alla duplice prescrizione dello stesso farmaco (associazione di farmaci della stessa classe). "
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- "In 2008, new criteria were established to detect inappropriate medication and to make physicians aware of 'right treatment' . The Screening Tool of Older Person's Prescriptions (STOPP) criteria consist of 65 clinically significant criteria for potentially inappropriate medications and the Screening Tool to Alert doctors to Right Treatment (START) criteria consist of 22 evidence-based prescribing indicators for commonly encountered diseases in older adults. "
ABSTRACT: Osteoporotic fractures are an increasing problem in the world due to the ageing of the population. Different models of orthogeriatric co-management are currently in use worldwide. These models differ for instance by the health-care professional who has the responsibility for care in the acute and early rehabilitation phases. There is no international consensus regarding the best model of care and which outcome parameters should be used to evaluate these models. The goal of this project was to identify which outcome parameters and assessment tools should be used to measure and compare outcome changes that can be made by the implementation of orthogeriatric co-management models and to develop recommendations about how and when these outcome parameters should be measured. It was not the purpose of this study to describe items that might have an impact on the outcome but cannot be influenced such as age, co-morbidities and cognitive impairment at admission.Injury 11/2013; 44(11-11):1403-12. DOI:10.1016/j.injury.2013.06.018 · 2.46 Impact Factor
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- "Several tools have been developed for measuring the appropriateness of treatment, and are classified into implicit: MAI  (Medication Appropriateness Index) and Hamdy Index ; and explicit methods: Beers criteria , IPET  (Not appropriate Prescribing in the elderly), STOPP/START  (Screening Tool of Older Person´s Potentially not Appropriate Prescription-Screening Tool to Alert doctors to Right Treatment), ACOVE  (Assessing care of vulnerable elders), CRIME  (CRIteria to assess appropriate Medication use among Elderly complex), and NORGEP  (Norwegian General Practice). Implicit methods (judgement-based) evaluate the treatment itself and take in consideration all patients characteristics, however, explicit methods (criterion-based) measure the appropriateness of prescribing to predefined criteria, usually mixture of data from the evidence and consensus. "
ABSTRACT: BACKGROUND: The original Medication Appropriateness Index was validated for elderly and polymedicated patients, both in hospital and outpatient contexts. However, no studies have applied this questionnaire in patients with multiple chronic conditions. The objective of this study is to assess the reliability of a modified Medication Appropriateness Index questionnaire in a population of patients with multiple chronic conditions. METHODS: We selected patients with multiple chronic conditions who were included in an integrated care project conducted at the Hospital Universitario Virgen del Rocío. To determine inter-observer reliability, each professional (internist or hospital pharmacy specialist) applied the questionnaire under the same conditions and with the same resources. To determine intra-observer reliability, each physician applied the tool at baseline and two months later. We measured inter- and intra-observer reliability using the kappa coefficient. The proportion of overall agreement was also determined. RESULTS: We obtained a weak overall kappa (k=0.38) for inter-observer reliability and moderate (k=0.52) and very good (k=0.84) values for intra-observer reliability of the internist and specialist in hospital pharmacy, respectively. The proportion of overall agreement is very high in all three situations: 96%, 98%, and 99%, respectively. CONCLUSIONS: Despite its limitations, the Medication Appropriateness Index questionnaire modified by our group can be used, as a reliable method, to assess the appropriateness of pharmacotherapy in patients with multiple chronic conditions.European Journal of Internal Medicine 02/2013; DOI:10.1016/j.ejim.2013.01.020 · 2.30 Impact Factor