Effectiveness of STOPP/START criteria in primary prevention of polypharmacy and under-treatment in older patients

Pala, Emel Ebru; Ersoy, Süleyman; Engin, Velittin Selçuk; Benli, Ali Ramazan

doi:10.1016/j.therap.2021.07.003

Cited by 3 publications

(7 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Following exclusion of 213 duplicate studies, 1258 studies were excluded by the titles and abstracts. Ninety-four studies with 371 224 692 older outpatients were included for analysis (Figure 1; eAppendix 2 in Supplement 1).…”

Section: Resultsmentioning

confidence: 99%

“…Forty-one studies were conducted in Asia, followed by 22 studies in Europe, 14 studies in North America, 8 studies in South America, 7 studies in Africa, and 2 studies in Oceania. Between 1999 and 2021, a total of 51 studies were performed in high-income countries, 23 studies in upper- to middle-income countries, 17 studies in lower- to middle-income countries, and 3 studies in low-income countries. Sixty-three studies of the PIM prevalence estimates were based on the Beers criteria, 26 studies…”

Section: Resultsmentioning

confidence: 99%

“…Between 1999 and 2021, a total of 51 studies were performed in high-income countries, 23 studies in upper- to middle-income countries, 17 studies in lower- to middle-income countries, and 3 studies in low-income countries. Sixty-three studies of the PIM prevalence estimates were based on the Beers criteria, 26 studies were based on the STOPP/START criteria, 13 studies on localization criteria that were developed based on the characteristics of medication for older patients in their own country, and 13 studies on other criteria. Eighty-five studies…”

Section: Resultsmentioning

confidence: 99%

“…Sixty-three studies of the PIM prevalence estimates were based on the Beers criteria, 26 studies were based on the STOPP/START criteria, 13 studies on localization criteria that were developed based on the characteristics of medication for older patients in their own country, and 13 studies on other criteria. Eighty-five studies were cross-sectional in design, and 11 studies were conducted in a national population survey. The mean age of the participants in most studies (65 studies…”

Section: Resultsmentioning

confidence: 99%

“…Eighty-five studies were cross-sectional in design, and 11 studies were conducted in a national population survey. The mean age of the participants in most studies (65 studies) was younger than 80 years and older than 65 years, and 31 studies had a mean number of drugs greater than 5. Thirty-four studies had a male ratio of more than 50%, and 34 studies included older outpatients with certain diseases.…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

Prevalence of Use of Potentially Inappropriate Medications Among Older Adults Worldwide

Tian,

Chen,

Zeng

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceThe use of potentially inappropriate medications (PIMs) is widespread yet continues to receive little attention in outpatient services.ObjectiveTo estimate the overall prevalence of PIM use in outpatient services.Data SourcesPubMed, Embase, and Web of Science were searched to identify relevant studies published from January 1, 1990, to November 21, 2022.Study SelectionObservational studies that reported the prevalence of PIM use among older patients in outpatient services were screened.Data Extraction and SynthesisTwo reviewers independently selected eligible articles, extracted data, and assessed the risk of bias. A random-effects meta-analysis was conducted to pool the prevalence estimates.Main Outcomes and MeasuresThe global patterns in the prevalence of PIM use among older patients in outpatient services were estimated, and the temporal trends and regional differences in PIM use were investigated.ResultsA total of 94 articles with 132 prevalence estimates were analyzed, including nearly 371.2 million older participants from 17 countries. Overall, the pooled prevalence of PIM use was 36.7% (95% CI, 33.4%-40.0%). Africa had the highest prevalence of PIM use (47.0%; 95% CI, 34.7%-59.4%), followed by South America (46.9%; 95% CI, 35.1%-58.9%), Asia (37.2%; 95% CI, 32.4%-42.2%), Europe (35.0%; 95% CI, 28.5%-41.8%), North America (29.0%; 95% CI, 22.1%-36.3%), and Oceania (23.6%; 95% CI, 18.8%-28.8%). In addition, the prevalence of PIM use is highest in low-income areas. Use of PIMs among older patients has become increasingly prevalent in the past 2 decades.Conclusions and RelevanceThis study of patterns of PIM use by different groups, such as geographic regions and World Bank countries, suggests noticeable geographic environment and economic income differences in the burden of PIMs in outpatient services. Furthermore, the high prevalence trend in the past 2 decades indicates that the global burden of PIM use continues to be worthy of attention.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Prevalence of Use of Potentially Inappropriate Medications Among Older Adults Worldwide

Tian,

Chen,

Zeng

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

show abstract

Under-Prescription of Drugs in the Elderly Population of Western Romania: An Analysis Based on STOPP/START Version 2 Criteria

Baneu,

Prelipcean,

Buda

et al. 2024

JCM

View full text Add to dashboard Cite

Background/Objectives: Numerous European countries, including Romania, are facing the concern of rapid ageing of their populations. Moreover, Romania’s life expectancy ranks among the lowest in the European Union. In light of this, it is imperative that the assessment of medication-related harm be given national priority in order to secure and enhance pharmacotherapy and the medical act. In this study, we sought to describe and evaluate the under-prescribing practices among the Romanian elderly population. Methods: We conducted a cross-sectional study in urban areas of two counties in Western Romania (Timis and Arad) from November 2017 to February 2019. We collected chronic electronic prescriptions issued for elderly patients (>65 years old) with chronic conditions. The medication was prescribed by generalist or specialist physicians for periods ranging between 30 and 90 days. To assess inappropriate prescribing behaviours, a multidisciplinary team of specialists applied the Screening Tool of Older Persons’ Prescriptions/Screening Tool to Alert to Right Treatment (STOPP/START) v.2 criteria to the collected prescriptions. Results: Within the 1498 prescriptions included in the study, 57% were issued to females, the mean age was 74.1 ± 6.95, and the average number of medicines per prescription was 4.7 ± 1.51. The STOPP criteria most commonly identified were the (1) long treatment duration (23.6%) and (2) prescription of neuroleptics (14.6%) or zopiclone (14.0%) as medications that increase the risk of falls. According to START criteria, the following medicines were under-prescribed: (1) statins (47.4%), (2) beta-blockers (24.5%), (3) antiresorptive therapy (10.0%), and (4) β2-agonists and muscarinic antagonists for chronic obstructive pulmonary disease (COPD) (4.5%). Within our study group, the prevalence of potentially inappropriate medications was 18.58%, whereas the prevalence of potential prescribing omissions was 49.2%. Conclusions: To decrease medication-related harm and morbid-mortality, and to increase the quality of life for elderly people in Romania, immediate actions are needed from national authorities. These actions include reinforcing primary care services, providing periodic training for physicians, implementing medication review services by pharmacists, and utilising electronic health records at their full capacity.

show abstract

Potentially Inappropriate Prescription and Impact of Physician Training on Usage of Prescribing Screening Tools for the Elderly in a Secondary Healthcare Facility

Kute,

Usifoh,

Oliorah

2024

PSNNJP

View full text Add to dashboard Cite

Background: Potentially Inappropriate Prescribing (PIP) for the elderly is widespread and is a risk factor for increased morbidity and mortality among them. The Beers criteria and “Screening Tools of Other Persons' potentially inappropriate Prescriptions (STOPP) and Screening Tools to Alert doctors to Right Treatment (START) criteria” have been validated to reduce PIP prevalence in the elderly when applied. However, many studies attest that a knowledge gap regarding PIP in geriatrics amongst prescribers contributes to the PIP surge. This study aims to assess the prevalence and predictors of PIP and also the impact of physician training on the usage of common prescribing tools for the elderly in a secondary healthcare facility. Methods: This study was a retrospective cross-sectional before- and -after study. Case ﬁles of 220 ambulatory patients aged 65 years and above were retrieved and screened for Potential Inappropriate Medicines (PIMs) and Potential Prescribing Omissions (PPOs) using the Beers criteria (2019) and STOPP/START criteria (2015). Subsequently a comprehensive training session was held forphysicians on the utilization of the Beers and STOPP/START criteria in geriatric pharmacotherapy and the use of screening tools-based smartphone application (app) in reducing PIP among the elderly. The prevalence and pattern of PIM/PPO before and after the intervention were compared on the same case ﬁles 2 months later to determine the impact of the training on the pattern and prevalence of PIP. Results: The mean age was 73.6±6.1years and 54.5% were males. About 76.1% of the population had multi-morbidity and hypertension was the most common aﬀecting 69.1% of participants while diabetes followed at 13.2%. The mean number of medications observed was 5.49±2.35 per patient before and 5.01±2.22 after the intervention. The most prescribed PIMs according to STOPP and Beers criteria before and after the intervention were methyldopa, glimepiride, and glibenclamide. However, amitriptyline also made the list of the most prescribed Beers drug while the most omitted START drug was regular inhaled corticosteroid for frequent exacerbation requiring systemic corticosteroid. The STOPP PIM prevalence was signiﬁcantly reduced from 37.7% to 29.1% after intervention (P= 0.045) while the START Potentially PPOs prevalence of 4.5% (P=0.5000) and Beers PIM prevalence of 30% (P=0.3014) were not signiﬁcantly reduced after the intervention. The overall PIP prevalence was reduced considerably from 24 in 100 patients to 18 in 100 patients (P=0.002) The binary logistic regression indicated that females, lower education, and multimorbidity, patients receiving more than ﬁve drugs, and those with active occupation were signiﬁcant predictors of PIP in this study. Conclusion: The prevalence of PIP among the elderly was relatively high. Beers and STOPP/START criteria-based educational training coupled with the introduction and installation of a smartphone screening tool application for physicians eﬀectively reduced overall PIP among the elderly. Continuous education in geriatric pharmacotherapy for physicians is necessary to reduce PIP prevalence in the elderly.

show abstract

Effectiveness of STOPP/START criteria in primary prevention of polypharmacy and under-treatment in older patients

Cited by 3 publications

References 28 publications

Prevalence of Use of Potentially Inappropriate Medications Among Older Adults Worldwide

Prevalence of Use of Potentially Inappropriate Medications Among Older Adults Worldwide

Under-Prescription of Drugs in the Elderly Population of Western Romania: An Analysis Based on STOPP/START Version 2 Criteria

Potentially Inappropriate Prescription and Impact of Physician Training on Usage of Prescribing Screening Tools for the Elderly in a Secondary Healthcare Facility

Contact Info

Product

Resources

About