Article

STOPP (Screening Tool of Older Persons's 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: 1.22). 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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    • "To ensure medication benefits are maintained several validated tools have been developed to help prescribers identify potential inappropriate prescribing in older adult care. [16] [18] [19] 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. "

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    • "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 [9] est la liste STOPP/START, développée en 2008 [10] [11]. Cet outil propose une liste de critères de prescription potentiellement inappropriée (versant STOPP) et une liste de critères d'omission potentielle (versant START) [12]. "

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