STOPP (Screening Tool of Older Persons’ Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation

Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland.
International journal of clinical pharmacology and therapeutics (Impact Factor: 1.04). 03/2008; 46(2):72-83. DOI: 10.5414/CPP46072
Source: PubMed

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.

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    • "Per ciascun farmaco sono state riportate anche le alternative terapeutiche. Il metodo STOPP and START [10], 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' [62]. 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. "
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    • "Several tools have been developed for measuring the appropriateness of treatment, and are classified into implicit: MAI [4] (Medication Appropriateness Index) and Hamdy Index [5]; and explicit methods: Beers criteria [6], IPET [7] (Not appropriate Prescribing in the elderly), STOPP/START [8] (Screening Tool of Older Person´s Potentially not Appropriate Prescription-Screening Tool to Alert doctors to Right Treatment), ACOVE [9] (Assessing care of vulnerable elders), CRIME [10] (CRIteria to assess appropriate Medication use among Elderly complex), and NORGEP [11] (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. "
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