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Published in: International Journal of Clinical Pharmacy 2/2013

01-04-2013 | Research Article

A comparison of the application of STOPP/START to patients’ drug lists with and without clinical information

Authors: Cristín Ryan, Denis O’Mahony, Dónal Óg O’Donovan, Emer O’Grady, Peter Weedle, Julia Kennedy, Stephen Byrne

Published in: International Journal of Clinical Pharmacy | Issue 2/2013

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Abstract

Background A European screening tool (STOPP/START) has been formulated to identify the prescribing of potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs). Pharmacists working in community pharmacies could use STOPP/START as a guide to conducting medication use reviews; however, community pharmacists do not routinely have access to patients’ clinical records. Objective To compare the PIM and PPO detection rates from application of the STOPP/START criteria to patients’ medication details alone with the detection rates from application of STOPP/START to information on patients’ medications combined with clinical information. Setting Community Pharmacy. Method Three pharmacists applied STOPP/START to 250 patient medication lists, containing information regarding dose, frequency and duration of treatment. The PIMs and PPOs identified by each pharmacist were compared with those identified by consensus agreement of two other pharmacists, who applied STOPP/START criteria using patients’ full clinical records. Main outcome measure The main outcome measures were: (1) PIM and PPO detection rates among pharmacists with access to patients’ clinical information compared to PIM and PPO detection rates among pharmacists using patients’ medication information only, and (2) the levels of agreement (calculated using Cohen’s kappa statistic (k)) for the three most commonly identified PIMs and PPOs. Results Pharmacists with access to patients’ clinical records identified significantly fewer PIMs than pharmacists without (p = 0.002). The three most commonly identified PIMs were benzodiazepines, proton pump inhibitors and duplicate drug classes, with kappa (k) statistic agreement ranges of 0.87–0.97, 0.60–0.68 and 0.39–0.85 respectively. PPOs were identified more often (p < 0.001) when clinical information was considered. The three most commonly identified PPOs were: bisphosphonates, β2-agonists and anti-platelets, with kappa (k) statistic agreement ranges of 0.89–1.0, 0.50–0.80 and 0.5–1.0 respectively. Conclusions PIM detection is likely to be overestimated using STOPP and PPO detection underestimated using START when STOPP/START is used in isolation of clinical information. Agreement for a selected number of criteria for which clinical information is not required is good, suggesting that some criteria may be reliably deployed without clinical information during a medicines use review. However, for STOPP/START criteria to be deployed more effectively by pharmacists, access to the full clinical record is recommended.
Literature
1.
go back to reference Gallagher P, O’Mahony D. Inappropriate prescribing in older people. Rev Clin Gerontol. 2008;12:65–76.CrossRef Gallagher P, O’Mahony D. Inappropriate prescribing in older people. Rev Clin Gerontol. 2008;12:65–76.CrossRef
2.
go back to reference Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2004;57:6–14.PubMedCrossRef Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2004;57:6–14.PubMedCrossRef
3.
4.
go back to reference Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D. STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46:72–83.PubMed Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D. STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46:72–83.PubMed
5.
go back to reference Ryan C, O’Mahony D, Kennedy J, Weedle P, Byrne S. Potential inappropriate prescribing in an Irish elderly population in primary care. Br J Clin Pharmacol. 2009;68:936–47.PubMedCrossRef Ryan C, O’Mahony D, Kennedy J, Weedle P, Byrne S. Potential inappropriate prescribing in an Irish elderly population in primary care. Br J Clin Pharmacol. 2009;68:936–47.PubMedCrossRef
6.
go back to reference Gallagher P, O’Mahony D. STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers’ criteria. Age Ageing. 2008;37:673–9.PubMedCrossRef Gallagher P, O’Mahony D. STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers’ criteria. Age Ageing. 2008;37:673–9.PubMedCrossRef
7.
go back to reference Barry PJ, Gallagher P, Ryan C, O’Mahony D. START (screening tool to alert doctors to the right treatment)-an evidence-based screening tool to detect prescribing omissions in elderly patients. Age Ageing. 2007;36:632–8.PubMedCrossRef Barry PJ, Gallagher P, Ryan C, O’Mahony D. START (screening tool to alert doctors to the right treatment)-an evidence-based screening tool to detect prescribing omissions in elderly patients. Age Ageing. 2007;36:632–8.PubMedCrossRef
8.
go back to reference O’Sullivan D, O’Mahony D, Parsons C, Hughes C, Patterson S, Byrne S. Inappropriate prescribing in Irish nursing homes residents. EGM. 2011;2:S11–2. O’Sullivan D, O’Mahony D, Parsons C, Hughes C, Patterson S, Byrne S. Inappropriate prescribing in Irish nursing homes residents. EGM. 2011;2:S11–2.
9.
go back to reference Gallagher PF, O’Connor MN, O’Mahony D. Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria. Clin Pharmacol Ther. 2011;89:845–54.PubMedCrossRef Gallagher PF, O’Connor MN, O’Mahony D. Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria. Clin Pharmacol Ther. 2011;89:845–54.PubMedCrossRef
10.
go back to reference Hamilton H, Gallagher P, Ryan C, Byrne S, O’Mahony D. Potentially inappropriate medications defined by STOPP Criteria and the risk of adverse drug events in older hospitalized patients. Arch Intern Med. 2011;171:1013–9.PubMedCrossRef Hamilton H, Gallagher P, Ryan C, Byrne S, O’Mahony D. Potentially inappropriate medications defined by STOPP Criteria and the risk of adverse drug events in older hospitalized patients. Arch Intern Med. 2011;171:1013–9.PubMedCrossRef
11.
go back to reference Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163(22):2716–24.PubMedCrossRef Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163(22):2716–24.PubMedCrossRef
12.
go back to reference National Service Framework for older people. Implementing medicines related aspects of the NSF for older people. London: Department of Health; 2001. National Service Framework for older people. Implementing medicines related aspects of the NSF for older people. London: Department of Health; 2001.
14.
go back to reference Ryan C, O’Mahony D, Byrne S. Application of STOPP and START criteria: inter-rater reliability among pharmacists. Ann Pharmacother. 2009;43:1239–44.PubMedCrossRef Ryan C, O’Mahony D, Byrne S. Application of STOPP and START criteria: inter-rater reliability among pharmacists. Ann Pharmacother. 2009;43:1239–44.PubMedCrossRef
15.
go back to reference Blenkinsopp A, Anderson C, Armstrong M. Systematic review of the effectiveness of community pharmacy-based interventions to reduce risk behaviours and risk factors for coronary heart disease. J Public Health Med. 2003;25:144–53.PubMedCrossRef Blenkinsopp A, Anderson C, Armstrong M. Systematic review of the effectiveness of community pharmacy-based interventions to reduce risk behaviours and risk factors for coronary heart disease. J Public Health Med. 2003;25:144–53.PubMedCrossRef
16.
go back to reference Reid F, Murray P, Storrie M. Implementation of a pharmacist-led clinic for hypertensive patients in primary care-a pilot study. Pharm World Sci. 2005;27:202–7.PubMedCrossRef Reid F, Murray P, Storrie M. Implementation of a pharmacist-led clinic for hypertensive patients in primary care-a pilot study. Pharm World Sci. 2005;27:202–7.PubMedCrossRef
17.
go back to reference Zermansky AG, Petty DR, Raynor DK, Freemantle N, Vail A, et al. Randomised controlled trial of clinical medication review by a pharmacist of elderly patients receiving repeat prescriptions in general practice. BMJ. 2001;323:1340–3.PubMedCrossRef Zermansky AG, Petty DR, Raynor DK, Freemantle N, Vail A, et al. Randomised controlled trial of clinical medication review by a pharmacist of elderly patients receiving repeat prescriptions in general practice. BMJ. 2001;323:1340–3.PubMedCrossRef
18.
go back to reference Lenaghan E, Holland R, Brooks A. Home-based medication review in a high risk elderly population in primary care-the POLYMED randomised controlled trial. Age Ageing. 2007;36:292–7.PubMedCrossRef Lenaghan E, Holland R, Brooks A. Home-based medication review in a high risk elderly population in primary care-the POLYMED randomised controlled trial. Age Ageing. 2007;36:292–7.PubMedCrossRef
19.
go back to reference Laaksonen R, Duggan C, Bates I. Performance of community pharmacists in providing clinical medication reviews. Ann Pharmacother. 2010;44:1181–90.PubMedCrossRef Laaksonen R, Duggan C, Bates I. Performance of community pharmacists in providing clinical medication reviews. Ann Pharmacother. 2010;44:1181–90.PubMedCrossRef
20.
go back to reference Krska J, Avery AJ. Evaluation of a medication review conducted by community pharmacists: a quantitative analysis of documented issues and recommendations. Br J Clin Pharmacol. 2007;65:386–96.PubMedCrossRef Krska J, Avery AJ. Evaluation of a medication review conducted by community pharmacists: a quantitative analysis of documented issues and recommendations. Br J Clin Pharmacol. 2007;65:386–96.PubMedCrossRef
Metadata
Title
A comparison of the application of STOPP/START to patients’ drug lists with and without clinical information
Authors
Cristín Ryan
Denis O’Mahony
Dónal Óg O’Donovan
Emer O’Grady
Peter Weedle
Julia Kennedy
Stephen Byrne
Publication date
01-04-2013
Publisher
Springer Netherlands
Published in
International Journal of Clinical Pharmacy / Issue 2/2013
Print ISSN: 2210-7703
Electronic ISSN: 2210-7711
DOI
https://doi.org/10.1007/s11096-012-9733-0

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