STOPP (Screening Tool of Older Person's 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.
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ABSTRACT: Background: The SENATOR trial utilises a computerised decision support system for doctors to optimise prescribing in older patients. For this, a comprehensive electronic drug file, incorporating drug information in a format such that it could be utilised in the six different European countries involved, was required. No such file currently exists. Objectives: Compile a standard drug file encompassing all the six sites. With the help of software development experts, incorporate this into the decision support system to generate outputs regarding drug price, appropriateness and suitable alternatives, specific to each country, for feedback to prescribers. Methods: It was decided that the critical information required was; ATC codes for every generic drug, all available brand names, strength and price per unit to the patient. Experts from each country provided guidance as to lists already available in their respective countries. These were surveyed and the presence or absence of the critical information was determined. The STOPP/START tool for assessing prescribing appropriateness was coded by ATC and ICD-10 codes for incorporation into the decision support tool also to enable feedback on prescribing appropriateness. Results: The critical information for the file was obtained from each country. In one country, BNF codes were used instead of ATC. In this instance, the BNF codes were mapped to ATC as the STOPP/START tool was coded using ATC. The lists were incorporated into the decision support system enabling prescribers in each country to input patients’ drug information easily and receive feedback on drug price, appropriateness and suitable alternatives, specific to their country. Conclusions: Valuable feedback, previously unavailable to prescribers can now be delivered in an electronic format and in a timely manner. The impact of such a facility on prescribing can now be thoroughly assessed. Also, since this file has significantly aided the collection of important drug data, it has opened up new avenues of research potential.EuroDURG, Groningen, The Netherlands; 08/2014
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ABSTRACT: Whilst multimorbidity is more prevalent with increasing age, approximately 30% of middle-aged adults (45-64 years) are also affected. Several prescribing criteria have been developed to optimise medication use in older people (≥65 years) with little focus on potentially inappropriate prescribing (PIP) in middle-aged adults. We have developed a set of explicit prescribing criteria called PROMPT (PRescribing Optimally in Middle-aged People's Treatments) which may be applied to prescribing datasets to determine the prevalence of PIP in this age-group. A literature search was conducted to identify published prescribing criteria for all age groups, with the Project Steering Group (convened for this study) adding further criteria for consideration, all of which were reviewed for relevance to middle-aged adults. These criteria underwent a two-round Delphi process, using an expert panel consisting of general practitioners, pharmacists and clinical pharmacologists from the United Kingdom and Republic of Ireland. Using web-based questionnaires, 17 panellists were asked to indicate their level of agreement with each criterion via a 5-point Likert scale (1 = Strongly Disagree, 5 = Strongly Agree) to assess the applicability to middle-aged adults in the absence of clinical information. Criteria were accepted/rejected/revised dependent on the panel's level of agreement using the median response/interquartile range and additional comments. Thirty-four criteria were rated in the first round of this exercise and consensus was achieved on 17 criteria which were accepted into the PROMPT criteria. Consensus was not reached on the remaining 17, and six criteria were removed following a review of the additional comments. The second round of this exercise focused on the remaining 11 criteria, some of which were revised following the first exercise. Five criteria were accepted from the second round, providing a final list of 22 criteria [gastro-intestinal system (n = 3), cardiovascular system (n = 4), respiratory system (n = 4), central nervous system (n = 6), infections (n = 1), endocrine system (n = 1), musculoskeletal system (n = 2), duplicates (n = 1)]. PROMPT is the first set of prescribing criteria developed for use in middle-aged adults. The utility of these criteria will be tested in future studies using prescribing datasets.BMC Health Services Research 01/2014; 14(1):484. · 1.66 Impact Factor
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ABSTRACT: Clinical pharmacist interventions have been shown to have positive effect on occurrence of drug-related issues as well as on clinical outcomes. However, evidence about which patients benefiting most from the interventions is limited. We aimed to explore whether pharmacist intervention is equally effective in preventing emergency department (ED) visits in patients with few or many prescribed drugs and in those with different levels of inappropriate prescribing.PLoS ONE 11/2014; 9(11):e111797. · 3.53 Impact Factor