STOPP (Screening Tool of Older Persons's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation
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.
Available from: Marco Spruit
- "Clinical medication reviews are 'structured, critical examination[s]of the patient's medicines with the objective of reaching an agreement with the patient about treatment, optimizing the impact of medicines, and minimizing the number of drug related problems'. Several clinical medication review methods have been developed to aid physicians and pharmacists in optimizing their prescriptions for these polypharmacy patients[18,19]. Implementations of these methods as decision support systems have been proven to improve the quality of prescriptions in research settings[9,19]. "
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ABSTRACT: Efficiency, or the resources spent while performing a specific task, is widely regarded as one the determinants of usability. In this study, the authors hypothesize that having a group of users perform a similar task over a prolonged period of time will lead to improvements in efficiency of that task. This study was performed in the domain of decision-supported medication reviews. Data was gathered during a randomized controlled trial. Three expert teams consisting of an independent physician and an independent pharmacist conducted 150 computerized medication reviews on patients in 13 general practices located in Amsterdam, the Netherlands. Results were analyzed with a linear mixed model. A fixed effects test on the linear mixed model showed a significant difference in the time required to conduct medication reviews over time; F(31.145) = 14.043, p < .001. The average time in minutes required to conduct medication reviews up to the first quartile was M = 20.42 (SD = 9.00), while the time from the third quartile up was M = 9.81 (SD = 6.13). This leads the authors to conclude that the amount of time users needed to perform similar tasks decreased significantly as they gained experience over time.
Available from: sciedupress.com
- "To ensure medication benefits are maintained several validated tools have been developed to help prescribers identify potential inappropriate prescribing in older adult care.    The significance of appropriate prescribing is best viewed in the context of the financial cost to the health service which has been identified by the Canadian Institute of Health Information (CIHI). In 2013, an estimated $34.5 billion was spent on drugs, the majority of which $29.3 billion (85.0%) was spent on prescribed drugs. "
Available from: Pierre Olivier Lang
- "Les critères STOPP/START.v2 : adaptation en langue française 3 seul outil explicite à ce jour à prendre en considération pour la détection des deux volets de la PMI dans la population âgée  est la liste STOPP/START, développée en 2008  . Cet outil propose une liste de critères de prescription potentiellement inappropriée (versant STOPP) et une liste de critères d'omission potentielle (versant START) . "
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