The impact of medication review with version 2 STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) criteria in a French nursing home: a 3-month follow-up study

Gaubert-Dahan, Marie-Line; Sebouai, Abdellatif; Tourid, W.; Fauvelle, F.; Aikpa, Raoul; Bonnet-Zamponi, Dominique

doi:10.1177/2042098619855535

Cited by 11 publications

(37 citation statements)

References 31 publications

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“…87 For instance, STOPP (Screening Tool of Older Persons' Prescriptions) and START (Screening Tool to Alert doctors to Right, ie, appropriate, indicated Treatment) can be used by healthcare professionals to appraise the appropriateness of medication prescriptions for older people in the context of his/her concurrent diagnoses and to be effective in reducing fall incidents, readmission to the healthcare settings, medication omissions, and medication costs. [88][89][90][91] Also, the execution of "NO TEARS" tool: Need and indication; Open questions; Tests and monitoring; Evidence and guidelines; Adverse events; Risk reduction or prevention; Simplification and switches 92 can provide an efficient medication review in a 10-minute consultation using audio-visual links. It serves as appropriate check and balance measure for prescribed and PRN medications at home and can minimize caregiver's fatigue.…”

Section: Support By Healthcare Professionalsmentioning

confidence: 99%

PRN Medicines Management for Older People with Long-Term Mental Health Disorders in Home Care

Vaismoradi¹,

Jamshed²,

Lorenzl³

et al. 2021

RMHP

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Older people with long-term mental health conditions who receive care in their own home are vulnerable to the inappropriate use of medications and polypharmacy given their underlying health conditions and comorbidities. Inappropriate use of pro re nata (PRN) medications in these older people can enhance their suffering and have negative consequences for their quality of life and well-being, leading to readmission to healthcare settings and the increased cost of health care. This narrative review on published international literature aims at improving our understanding of medicines management in home care and how to improve PRN medication use among older people with long-term health conditions in their own home. Accordingly, the improvement of PRN medicines management for these older people requires the development of an individualised care plan considering 'reduction of older people's dependence on PRN medications', 'empowerment of family caregivers', and 'support by healthcare professionals.' PRN medication use should be reduced through deprescription and discontinuation strategies. Also, older people and their family caregivers should be encouraged to prioritize the use of non-pharmacologic methods to relieve physical and psychological problems. Besides the empowerment of family caregivers through role development, education and training about PRN medications, and involvement in decision-making, they need support by the multidisciplinary network in terms of supervision, monitoring, and home visits.

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Section: Support By Healthcare Professionalsmentioning

confidence: 99%

PRN Medicines Management for Older People with Long-Term Mental Health Disorders in Home Care

Vaismoradi¹,

Jamshed²,

Lorenzl³

et al. 2021

RMHP

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“…The majority of studies had been conducted in hospitals, most frequently across multiple departments (n = 25). 49,52,[54][55][56][57][58]60,64,[66][67][68][69][70][71][72][73][74]77,78,80,82,83,85,87 Other studies were conducted in nursing homes (n = 9), 59,61,62,65,75,79,81,84,88 primary care (n = 5) 50,51,53,63,86 or a community pharmacy (n = 1) 76 . The majority of studies (n = 29) 49, 51-53,56-59,62,65,68-71,73-77,79,81-88 used both STOPP and START tools.…”

Section: Descriptive Summary Of Included Studiesmentioning

confidence: 99%

“…The quality appraisal of the studies has been presented in separate tables. For nonrandomised studies, out of 28 studies, 18 studies 49,[56][57][58][59][60][61][62][63][64][65]68,69,74,75,77,79,85 were scored as being of high quality and 10 studies 52,66,67,72,76,80,81,[86][87][88] scored as being of medium quality (see Appendix 9, Table 21). For RCTs, out of 12 studies, 11 studies 50,51,[53][54][55]70,71,73,[82][83][84] scored as being of high importance and only one study 78 was scored as being of medium importance (see Appendix 10, Table 22).…”

Section: Critical Appraisalmentioning

confidence: 99%

“…Methodological limitations were found in all the studies, including uncontrolled groups, short follow-ups, small sample sizes, potential selection bias and insufficient information on confounding factors. Furthermore, generalisability was limited, as 25 49,[52][53][54][55]57,58,[60][61][62][64][65][66][67][68][69][70][71][72]74,77,78,80,82,83,85,87 of the 40 studies were conducted in a single institution or hospital or nursing home or clinical units.…”

Section: Critical Appraisalmentioning

confidence: 99%

“…Nine studies 59,61,62,65,75,79,81,84,88 were conducted in nursing homes. The studies took place in Spain (n = 4), 61,79,84,88 Norway (n = 1), 59 France (n = 1), 62 Serbia (n = 1), 65 Portugal (n = 1) 75 and the Netherlands (n = 1).…”

Section: Hospitalsmentioning

confidence: 99%

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STOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis

Gangannagaripalli

Porter

Davey

et al. 2021

Health Serv Deliv Res

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Background Drug-related problems and potentially inappropriate prescribing impose a huge burden on patients and the health-care system. The most widely used tools for appropriate prescription in older adults in England and in other European countries are the Screening Tool of Older People’s Prescriptions (STOPP)/Screening Tool to Alert to the Right Treatment (START) tools. STOPP/START tools support medicines optimisation for older adults. Objectives To identify, test and refine the programme theories underlying how interventions based on the STOPP/START tools are intended to work, for whom, in what circumstances and why, as well as the resource use and cost requirements or impacts. Design A realist synthesis. Setting Primary care, hospital care and nursing homes. Patients Patients aged ≥ 65 years. Interventions Any intervention based on the use of the STOPP/START tools. Review methods Database and web-searching was carried out to retrieve relevant evidence to identify and test programme theories about how interventions based on the use of the STOPP/START tools work. A project reference group made up of health-care professionals, NHS decision-makers, older people, carers and members of the public was set up. In phase 1 we identified programme theories about STOPP/START interventions on how, for whom, in what contexts and why they are intended to work. We searched the peer-reviewed and grey literature to identify documents relevant to the research questions. We interviewed experts in the field in our reference group to gain input on our list of candidate context–mechanism–outcome configurations, to identify additional context–mechanism–outcome configurations and to identify additional literature and/or relevant concepts. In phase 2 we reviewed and synthesised relevant published and unpublished empirical evidence and tested the programme theories using evidence from a larger set of empirical studies. Results We developed a single logic model structured around three key mechanisms: (1) personalisation, (2) systematisation and (3) evidence implementation. Personalisation: STOPP/START-based interventions are based on shared decision-making, taking into account patient preferences, experiences and expectations (mechanisms), leading to increased patient awareness, adherence, satisfaction, empowerment and quality of life (outcomes). Systematisation: STOPP/START tools provide a standardised/systematic approach for medication reviews (mechanisms), leading to changes in professional and organisational culture and burden/costs (outcomes). Evidence implementation: delivery of STOPP/START-based interventions is based on the implementation of best evidence (mechanisms), reducing adverse outcomes through appropriate prescribing/deprescribing (outcomes). For theory testing, we identified 40 studies of the impact of STOPP/START-based interventions in hospital settings, nursing homes, primary care and community pharmacies. Most of the interventions used multiple mechanisms. We found support for the impact of the personalisation and evidence implementation mechanisms on selected outcome variables, but similar impact was achieved by interventions not relying on these mechanisms. We also observed that the impact of interventions was linked to the proximity of the selected outcomes to the intervention in the logic model, resulting in a clearer benefit for appropriateness of prescribing, adverse drug events and prescription costs. Limitations None of the available studies had been explicitly designed for evaluating underlying causal mechanisms, and qualitative information was sparse. Conclusions No particular configuration of the interventions is associated with a greater likelihood of improved outcomes in given settings. Study registration This study is registered as PROSPERO CRD42018110795. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 23. See the NIHR Journals Library website for further project information.

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Adopting STOPP/START Criteria Version 3 in Clinical Practice: A Q&A Guide for Healthcare Professionals

Lunghi,

Domenicali,

Vertullo

et al. 2024

Drug Saf

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The growing complexity of geriatric pharmacotherapy necessitates effective tools for mitigating the risks associated with polypharmacy. The Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions (STOPP)/Screening Tool to Alert doctors to Right Treatment (START) criteria have been instrumental in optimizing medication management among older adults. Despite their large adoption for improving the reduction of potentially inappropriate medications (PIM) and patient outcomes, the implementation of STOPP/START criteria faces notable challenges. The extensive number of criteria in the latest version and time constraints in primary care pose practical difficulties, particularly in settings with a high number of older patients. This paper critically evaluates the challenges and evolving implications of applying the third version of the STOPP/START criteria across various clinical settings, focusing on the European healthcare context. Utilizing a “Questions & Answers” format, it examines the criteria’s implementation and discusses relevant suitability and potential adaptations to address the diverse needs of different clinical environments. By emphasizing these aspects, this paper aims to contribute to the ongoing discourse on enhancing medication safety and efficacy in the geriatric population, and to promote more person-centred care in an aging society. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-024-01453-1.

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The impact of medication review with version 2 STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) criteria in a French nursing home: a 3-month follow-up study

Cited by 11 publications

References 31 publications

PRN Medicines Management for Older People with Long-Term Mental Health Disorders in Home Care

PRN Medicines Management for Older People with Long-Term Mental Health Disorders in Home Care

STOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis

Adopting STOPP/START Criteria Version 3 in Clinical Practice: A Q&A Guide for Healthcare Professionals

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