STOPP/START criteria for potentially inappropriate medications/potential prescribing omissions in older people: origin and progress. Issue 1 (2nd January 2020)

• Record Type: Journal Article
• Authors: O'Mahony, Denis
• Is Part Of: Expert review of clinical pharmacology. Volume 13:Issue 1(2020)
• Page Start: 15
• Page End: 22
• Publication Date: 2020-01-02
• Subjects: Adverse drug event -- adverse drug reaction -- elderly -- hospital -- inappropriate prescribing -- nursing home -- patient safety -- prevention -- primary care -- STOPP/START criteria; Clinical pharmacology -- Periodicals; 615.105
• DOI: 10.1080/17512433.2020.1697676
• Languages: English
• ISSNs: 1751-2433

Abstract

ABSTRACT: Introduction : STOPP (Screening Tool of Older Persons' Prescriptions) and START (Screening Tool to Alert to Right Treatment) are explicit criteria that facilitate medication review in multi-morbid older people in most clinical settings. This review examines the clinical trial evidence pertaining to STOPP/START criteria as an intervention. Areas covered : The literature was searched for registered clinical trials that used STOPP/START criteria as an intervention. In single-center trials, applying STOPP/START criteria improved medication appropriateness, reduced polypharmacy, reduced adverse drug reactions (ADRs), led to fewer falls, and lower medication costs. Two large-scale multi-center trials (SENATOR and OPERAM) examined the impact of computer-generated STOPP/START criteria on incident ADRs (SENATOR) and drug-related hospitalizations (OPERAM) in multi-morbid older people. Results of these trials will be publicized in 2020. Expert opinion : Applying STOPP/START criteria improves clinical outcomes in multi-morbid older people. Electronic deployment of STOPP/START criteria is a substantial technical challenge; however, recent clinical trials of software prototypes demonstrate feasibility. Even with well-functioning software for the application of STOPP/START criteria, the need remains for face-to-face interaction between attending clinicians and appropriately trained personnel (likely pharmacists) to explain and qualify specific STOPP/START recommendations in individual multi-morbid older patients. Such interaction is essential for the implementation of relevant STOPP/START recommendations.