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

Abstract

To evaluate the appropriateness/inappropriateness of medication prescribing using the Screening Tool of Older Person's Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) criteria in elderly homebased primary care (HBPC) veterans and to understand the potential impact of the HBPC team on the STOPP/START criteria. Retrospective chart review between September 1, 2007, and September 30, 2009. Edward Hines, Jr. VA Hospital, Hines, Illinois, a tertiary care referral center. Two hundred patients 65 years of age and older who had an initial interdisciplinary evaluation conducted by the HBPC team. Exclusion criteria included admission to the hospital between the initial and follow-up medication review, admission to the HBPC program for palliative or hospice care, or death before completion of a follow-up evaluation. Appropriateness/inappropriateness of medication prescribing was assessed by comparing the medication list at the initial pharmacist medication review and follow-up review. Initial and follow-up STOPP and START scores were calculated for each patient. The primary outcome was to evaluate the appropriateness/inappropriateness of medication prescribing using the STOPP/START criteria. The secondary outcome was to understand the potential impact of the HBPC team on the STOPP/START criteria. There was a statistically significant decrease in the STOPP score between the initial and follow-up medication review (P = 0.0014). There was not a statistically significant increase in the START score between the initial and follow-up medication review (P = 0.5720). A statistically significant decrease in the STOPP score was found. Although the START score increased, the change was not found to be statistically significant.