Application of the STOPP/START criteria: a systematic review of the prevalence of potentially inappropriate prescribing in older adults, and evidence of clinical, humanistic and economic impact

Abstract

of older person's potentially inappropriate prescriptions, screening tool to alert doctors to the right treatment SUMMARYWhat is known and Objective: Potentially inappropriate prescribing (PIP) has significant clinical, humanistic and economic impacts. Identifying PIP in older adults may reduce their burden of adverse drug events. Tools with explicit criteria are being developed to screen for PIP in this population. These tools vary in their ability to identify PIP in specific care settings and jurisdictions due to such factors as local prescribing practices and formularies. One promising set of screening tools are the STOPP (Screening Tool of Older Person's potentially inappropriate Prescriptions) and START (Screening Tool of Alert doctors to the Right Treatment) criteria. We conducted a systematic review of research studies that describe the application of the STOPP/START criteria and examined the evidence of the impact of STOPP/START on clinical, humanistic and economic outcomes in older adults. Methods: We performed a systematic review of studies from relevant biomedical databases and grey literature sources published from January 2007 to January 2012. We searched citation and reference lists and contacted content experts to identify additional studies. Two authors independently selected studies using a predefined protocol. We did not restrict selection to particular study designs; however, non-English studies were excluded during the selection process. Independent extraction of articles by two authors used predefined data fields. For randomized controlled trials and observational studies comparing STOPP/START to other explicit criteria, we assessed risk of bias using an adapted tool. Results and Discussion: We included 13 studies: a single randomized controlled trial and 12 observational studies. We performed a descriptive analysis as heterogeneity of study populations, interventions and study design precluded metaanalysis. All observational studies reported the prevalence of PIP; however, the application of the criteria was not consistent across all studies. Seven of the observational studies compared STOPP/ START with other explicit criteria. The STOPP/START criteria were reported to be more sensitive than the more-frequentlycited Beers criteria in six studies, but less sensitive than a set of criteria developed in Australia. The STOPP criteria identified more medications associated with adverse drug events than the 2002 version of the Beers criteria. Patients with PIP, as identified by STOPP, had an 85% increased risk of adverse drug events in one study (OR = 1Á85, 95% CI: 1Á51-2Á26; P < 0Á001). There was limited evidence that the application of STOPP/START criteria optimized prescribing. Research involving the application of STOPP/START on the impact on the quality of life was not found. The direct costs of PIP were documented in three studies from Ireland, but more extensive analyses on the economic impact or studies from other jurisdictions were not found. What is new and Conclusion: The STOPP/START c...

Exposure to potentially inappropriate medications in Brazilian elderly outpatients with metabolic diseases

“…A systematic review evaluated 13 studies (12 observational studies and 1 randomized controlled trial) that investigated the prevalence of PIMs in older adults (Hill-Taylor et al, 2013 5.6% (6) aspirin + warfarin without anti-H2 or PPI 0.9% (1) amlodipine in constipated patient 0.9% (1) thiazide diuretics in patients with gout 6.5% (7) furosemide for edema without signs of CHF 2.8% (3) carvedilol in patient with urinary incontinence 0.9% (1) 2 beta-blockers; 2 ACE inhibitors (Duplication of pharmacological class) 1.9% (2) Endocrine glibenclamide in T2D patients 21.3% (23) propranolol in patients with hypoglycemic episode 1.9% (2) Central nervous amitriptyline and calcium channel blocker (1 patient with glaucoma and BPH) 1.8% (2) Respiratory theophylline as monotherapy for COPD 0.9% (1) Skeletal muscle diclofenac in patient with CRF and hypertension 0.9% (1) Number of PIMs in parenthesis. ACE: angiotensin converting enzyme; Anti-H2: antihistamine; BPH: benign prostate hyperplasia; CHF: cardiac heart failure; COPD: chronic obstructive pulmonary disease; CRF: chronic renal failure; PPI: proton pump inhibitor; PIMs: potentially inappropriate medications; T2D: type 2 diabetes.…”

Yaşlılarda doğru ilaç kullanımı

“…Beers kriterlerinin eksik olduğu düşünülen yönlerini tamamlamaları ve Avrupa kıtası ülkelerinde kullanılan ilaçları içermeleri nedeniyle bu iki tarama aracı Avrupa ülkelerinde yaygın olarak kullanılmışlardır (32).…”

Inappropriate prescribing, non-adherence to long-term medications and related morbidities : Pharmacoepidemiological aspects

“…However, there is a large variation in the prevalence of PIPs between studies, depending on the study setting and design and the PIPs criteria used (101,229,230). Notwithstanding, STOPP criteria have been found more sensitive than others in detecting PIPs in European healthcare settings (231)(232)(233). The prevalence of PIPs in studies based on STOPP criteria have ranged between 21% and 79% (233).…”

“…Notwithstanding, STOPP criteria have been found more sensitive than others in detecting PIPs in European healthcare settings (231)(232)(233). The prevalence of PIPs in studies based on STOPP criteria have ranged between 21% and 79% (233). However, the comparison between studies should be done with caution because of different settings and populations.…”