Appropriateness of Medication Prescribing Using the STOPP/START Criteria in Veterans Receiving Home-Based Primary Care

Brahmbhatt, Millie; Palla, Kavita; Kossifologos, Annette; Mitchell, Dayna; Lee, Todd A.

doi:10.4140/tcp.n.2013.361

Cited by 10 publications

(21 citation statements)

References 14 publications

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“…The use of STOPP/START criteria in improving health care outcomes in primary care, remains to be established. However, recent findings in secondary care may be promising [28]–[30]. It has been argued that primary care pharmacists may overestimate the rate of PIM and underestimate the rate of PPO when using STOPP and START criteria due to lack of clinical information [14].…”

Section: Discussionmentioning

confidence: 99%

Potentially Inappropriate Prescribing in Older Primary Care Patients

Kovačević

Simišić²,

Rudinski³

et al. 2014

PLoS ONE

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ObjectivesThe aim of the study was to determine the rate of Potentially Inappropriate Medicines (PIM) and Potential Prescription Omissions (PPO) according to Screening Tool of Older Person's potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment (STOPP/START) criteria.Study DesignA cross-sectional survey in community pharmacy.MethodA prospective cross-sectional study was performed, during March-May 2012, in five community pharmacies. Patients aged ≥65 years, who collected one or more prescribed medications, were asked to participate in the study, and an interview was scheduled. Patients were asked to provide their complete medical and biochemical record from their general practitioner.Results509 patients, mean age 74.8±6.5 years, 57.4% female, participated in the study. 164 PIM were identified in 139 patients (27.3%). The most common were: long-term use of long-acting benzodiazepines (20.7%), use of non-steroidal antiinflammatory drugs (NSAID) in patients with moderate-severe hypertension (20.1%), use of theophylline as monotherapy for chronic obstructive pulmonary disease (COPD, 15.9%) and use of aspirin without appropriate indication (15.2%). Patients with more than four prescpritions had a higher risk for PIM (OR 2.85, 95% CI 1.97–4.14, p<0.001). There were 439 PPO, identified in 257, (50.5%) patients. Predictors for PPO were older age, presence of diabetes, myocardial infarction, osteoporosis, stroke, COPD and/or angina pectoris.ConclusionSTOPP/START criteria may be useful in identifying inappropriate prescribing and improving the current prescribing practices. Pharmacists should focus more on patients with more than four medications and/or patients with gout or pain accompanied with arterial hypertension because those patient may be at higher risk of PIM. Additionlly, patients older than 74 years with diabetes, osteoporosis, myocardial infarction, stroke, angina pectoris and/or COPD may have an increased risk of PPO.

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Section: Discussionmentioning

confidence: 99%

Potentially Inappropriate Prescribing in Older Primary Care Patients

Kovačević

Simišić²,

Rudinski³

et al. 2014

PLoS ONE

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“…One such criteria is the “Screening Tool to Alert doctors to the Right Treatment and the Screening Tool of Older Persons’ potentially inappropriate Prescriptions” (START/STOPP) Criteria. This tool goes a step further from the Beers list in addressing medications possibly indicated for older adults, as well as expanding on those that should be taken away [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…The START/STOPP criteria were used to comprehensively evaluate the appropriateness of medication regimens in older adults in a study by Brahmbhatt et al [ 8 ]. While this study found a significant reduction in the STOPP score between initial and follow up medication reviews, it did not find a significant increase in the START score.…”

Section: Introductionmentioning

confidence: 99%

“…The overarching goal of ‘using screening’ tools such as the START/STOPP criteria is to help identify potential medications that have an increased risk for falls and adverse effects on the elderly. Through management of their complex, numerous medications, many adverse effects due to multiple medications can be prevented [ 6 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Pharmacist-Conducted Comprehensive Medication Reviews for Older Adult Patients to Reduce Medication Related Problems

Kiel

Phillips²

2017

Pharmacy

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Older adults are demanding increased healthcare attention with regards to prescription use due in large part to highly complex medication regimens. As patients age, medications often have a more pronounced effect on older adults, negatively impacting patient safety and increasing healthcare costs. Comprehensive medication reviews (CMRs) optimize medications for elderly patients and help to avoid inappropriate medication use. Previous literature has shown that such CMRs can successfully identify and reduce the number of medication-related problems and improve acute healthcare utilization. The purpose of this pharmacy resident research study is to examine the impact of pharmacist-conducted geriatric medication reviews to reduce medication-related problems within a leading community health system in southwest Michigan. Furthermore, the study examines type of pharmacist interventions made during medication reviews, acute healthcare utilization, and physician assessment of the pharmacist’s value. The study was conducted as a retrospective post-hoc analysis on ambulatory patients who received a CMR by a pharmacist at a primary care practice. Inclusion criteria included patients over 65 years of age with concurrent use of at least five medications who were a recent recipient of a CMR. Exclusion criteria included patients with renal failure, or those with multiple providers involved in primary care. The primary outcome was the difference in number of medication-related problems, as defined by the START and STOPP Criteria (Screening Tool to Alert doctors to Right Treatment/Screening Tool of Older Persons’ Prescriptions). Secondary outcomes included hospitalizations, emergency department visits, number and type of pharmacist interventions, acceptance rate of pharmacist recommendations, and assessment of the pharmacist’s value by clinic providers. There were a total of 26 patients that received a comprehensive medication review from the pharmacist and were compared to a control group, patients that did not receive a CMR. The average patient age for both groups was 76 years old. A total of 11 medication-related problems in the intervention group patients were identified compared with 24 medication-related problems in the control group (p-value 0.002). Pharmacist-led comprehensive medication reviews were associated with a statistically significant different in the number of medication-related problems as defined by the START and STOPP criteria.

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“…Adverse drug reactions include a negative reaction to pharmacotherapy including confusion, depression, constipation, falls, fractures, delirium, possible hospitalization, and mortality (Cahir et al, 2010;Shahezwan, 2012;Hamilton, 2009;Brahmbhatt, Palla, Kossifologos, Mitchell, and Lee, 2013;Pretorius et al, 2013). Potentially inappropriate medications may be detected with a medication review (Hamilton, Gallagher, O'Mahony, 2009;O'Sullivan, O'Mahony, Parsons, Murphy, Patterson, Byrne, 2013).…”

Section: Theoretical Frameworkmentioning

confidence: 99%

Retrospective Study to Describe and Compare the Application of Select Sections of the STOPP/START and Beers Criteria in Medication Reviews in a Musculoskeletal Specialty Practice

Linder¹

2013

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Appropriateness of Medication Prescribing Using the STOPP/START Criteria in Veterans Receiving Home-Based Primary Care

Abstract: A statistically significant decrease in the STOPP score was found. Although the START score increased, the change was not found to be statistically significant.

Cited by 10 publications

References 14 publications

Potentially Inappropriate Prescribing in Older Primary Care Patients

Potentially Inappropriate Prescribing in Older Primary Care Patients

Impact of Pharmacist-Conducted Comprehensive Medication Reviews for Older Adult Patients to Reduce Medication Related Problems

Retrospective Study to Describe and Compare the Application of Select Sections of the STOPP/START and Beers Criteria in Medication Reviews in a Musculoskeletal Specialty Practice

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