Evaluation of clarity of the STOPP/START criteria for clinical applicability in prescribing for older people: a quality appraisal study

Sallevelt, Bastiaan T G M; Huibers, Corlina Johanna Alida; Knol, Wilma; Puijenbroek, Eugène van; Egberts, Toine C. G.; Wilting, Ingeborg

doi:10.1136/bmjopen-2019-033721

Cited by 15 publications

(18 citation statements)

References 27 publications

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“…Deprescribing has been associated with lower mortality in older person nursing departments and in institutional settings has been associated with reduced hospitalisation and maintenance of quality of life [51]. However, the commonly used Beers criteria [54] and STOPP/START describing tools [55] contain recommendations around the deprescribing of medications with key prognostic or symptomatic importance in heart failure. These tools have not been studied in a heart failure population and should only be used within the confines of an adequately designed study to assess their effectiveness and safety.…”

Section: Discussionmentioning

confidence: 99%

Polypharmacy definition and prevalence in heart failure: a systematic review

et al. 2021

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Polypharmacy and heart failure are becoming increasingly common due to an ageing population and the rise of multimorbidity. Treating heart failure necessitates prescribing of multiple medications, in-line with national and international guidelines predisposing patients to polypharmacy. This review aims to identify how polypharmacy has been defined among heart failure patients in the literature, whether a standard definition in relation to heart failure could be identified and to describe the prevalence. The Healthcare Database Advanced Search (HDAS) was used to search EMBASE, MEDLINE, PubMed, Cinahl and PsychInfo from inception until March 2021. Articles were included of any design, in patients ≥ 18 years old, with a diagnosis of heart failure; that explicitly define and measure polypharmacy. Data were thereafter extracted and described using a narrative synthesis approach. A total of 7522 articles were identified with 22 meeting the inclusion criteria. No standard definition of polypharmacy was identified. The most common definition was that of " ≥ 5 medications." Polypharmacy prevalence was high in heart failure populations, ranging from 17.2 to 99%. Missing or heterogeneous methods for defining heart failure and poor patient cohort characterisation limited the impact of most studies. Polypharmacy, most commonly defined as ≥ 5 medications, is highly prevalent in the heart failure population. There is a need for an internationally agreed definition of polypharmacy, allowing accurate review of polypharmacy issues. Whether an arbitrary numerical cut-off is a suitable definition, rather than medication appropriateness, remains unclear. Further studies are necessary to understand the relationship between polypharmacy with specific types of heart failure and related comorbidities.

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Section: Discussionmentioning

confidence: 99%

Polypharmacy definition and prevalence in heart failure: a systematic review

et al. 2021

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“…To incorporate guideline recommendations into the CDSS, STOPP/START criteria were converted into algorithms; however, many lacked sufficient clarity for translation [ 9 , 23 , 24 ]. STOPP A2 (Any drug prescribed beyond the recommended duration, where treatment duration is well defined) could not be coded at all, and some elements of other criteria were left out (e.g.…”

Section: Discussionmentioning

confidence: 99%

Frequency and Acceptance of Clinical Decision Support System-Generated STOPP/START Signals for Hospitalised Older Patients with Polypharmacy and Multimorbidity

et al. 2021

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Background The Screening Tool of Older Persons' Prescriptions (STOPP)/Screening Tool to Alert to Right Treatment (START) instrument is used to evaluate the appropriateness of medication in older people. STOPP/START criteria have been converted into software algorithms and implemented in a clinical decision support system (CDSS) to facilitate their use in clinical practice. Objective Our objective was to determine the frequency of CDSS-generated STOPP/START signals and their subsequent acceptance by a pharmacotherapy team in a hospital setting. Design and Methods Hospitalised older patients with polypharmacy and multimorbidity allocated to the intervention arm of the OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly) trial underwent a CDSS-assisted structured medication review in four European hospitals. We evaluated the frequency of CDSS-generated STOPP/START signals and the subsequent acceptance of these signals by a trained pharmacotherapy team consisting of a physician and pharmacist after evaluation of clinical applicability to the individual patient, prior to discussing pharmacotherapy optimisation recommendations with the patient and attending physicians. Multivariate linear regression analysis was used to investigate potential patient-related (e.g. age, number of co-morbidities and medications) and setting-related (e.g. ward type, country of inclusion) determinants for acceptance of STOPP and START signals. ResultsIn 819/826 (99%) of the patients, at least one STOPP/START signal was generated using a set of 110 algorithms based on STOPP/START v2 criteria. Overall, 39% of the 5080 signals were accepted by the pharmacotherapy team. There was a high variability in the frequency and the subsequent acceptance of the individual STOPP/START criteria. The acceptance ranged from 2.5 to 75.8% for the top ten most frequently generated STOPP and START signals. The signal to stop a drug without a clinical indication was most frequently generated (28%), with more than half of the signals accepted (54%). No difference in mean acceptance of STOPP versus START signals was found. In multivariate analysis, most patient-related determinants did not predict acceptance, although the acceptance of START signals increased in patients with one or more hospital admissions (+ 7.9; 95% confidence interval [CI] 1.6-14.1) or one or more falls in the previous year (+ 7.1; 95% CI 0.7-13.4). A higher number of co-morbidities was associated with lower acceptance of STOPP (− 11.8%; 95% CI − 19.2 to − 4.5) and START (− 11.0%; 95% CI − 19.4 to − 2.6) signals for patients with more than nine and between seven and nine co-morbidities, respectively. For setting-related determinants, the acceptance differed significantly between the participating trial sites. Compared with Switzerland, the acceptance was higher in Ireland (STOPP: + 26.8%; 95% CI 16.8-36.7; START: + 31.1%; 95% CI 18.2-44.0) and in the Netherlands (STOPP: + 14.7%; 95% CI 7.8-21.7). Admission to a surgical ward was positively associated w...

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“…Previous studies have also shown that monitoring instructions need improvement 16 17 22–24. Brouwer et al assessed the applicability of monitoring instructions in CPGs for elderly patients treated with antipsychotic drugs 23.…”

Section: Discussionmentioning

confidence: 99%

“…Clear and easily applicable CPGs could enhance monitoring in daily practice and thereby contribute to the safety of antipsychotic drug use in children. However, previous studies have shown that the monitoring instructions are not always clearly described in the CPGs and that the instructions are not always easily applicable in daily clinical practice 16 17. This could lead to suboptimal monitoring frequencies and, consequently, to unidentified ADRs.…”

Section: Introductionmentioning

confidence: 99%

Clarity and applicability of adverse drug reaction-related monitoring instructions in clinical practice guidelines for children and adolescents treated with antipsychotic drugs: a review of six clinical practice guidelines

et al. 2022

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ObjectivesMonitoring instructions related to adverse drug reactions (ADRs) are not always clearly described in clinical practice guidelines (CPGs) and not always easily applicable in daily clinical practice. The aim of this study was to assess the clarity of presentation and the applicability of ADR-related monitoring instructions in CPGs for children and adolescents treated with antipsychotic drugs.SettingGuidelines from different countries were selected, and monitoring instructions for 13 ADR-related parameters were assessed.Primary and secondary outcome measuresTo assess the clarity and the applicability of the sections concerning monitoring instructions in each CPG, the Appraisal of Guidelines for Research and Evaluation instrument was used. To assess the clarity and the applicability of the monitoring instructions for each ADR-related parameter, the Systematic Information for Monitoring score was used.ResultsSix CPGs were included. Overall, the presentation of the monitoring instructions in the different CPGs was clear; three CPGs scored >75%. All CPGs scored lower on applicability, as, for example, the barriers and facilitators were poorly described. The number of ADR-related parameters included in the CPGs varied between 8 and 13. Why and what to monitor was always described for each parameter. When to start monitoring was also often described (90.2%), but when to stop monitoring was less frequently described (37.4%).ConclusionsThe CPGs differed on the parameters that needed to be monitored. Overall, the monitoring instructions were clearly presented, but improvement in their applicability is required. By improving the monitoring instructions, CPGs can provide better guidance on monitoring ADRs in daily clinical practice.

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Evaluation of clarity of the STOPP/START criteria for clinical applicability in prescribing for older people: a quality appraisal study

Cited by 15 publications

References 27 publications

Polypharmacy definition and prevalence in heart failure: a systematic review

Polypharmacy definition and prevalence in heart failure: a systematic review

Frequency and Acceptance of Clinical Decision Support System-Generated STOPP/START Signals for Hospitalised Older Patients with Polypharmacy and Multimorbidity

Clarity and applicability of adverse drug reaction-related monitoring instructions in clinical practice guidelines for children and adolescents treated with antipsychotic drugs: a review of six clinical practice guidelines

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