Clinical relevance of the STOPP/START criteria in hip fracture patients

Johan Lönnbro,Susanna M Wallerstedt

doi:10.1007/s00228-016-2188-9

Abstract

PurposeThe aim of this study was to investigate the clinical relevance of potentially inappropriate medications (PIMs), identified by the STOPP criteria, and potential prescribing omissions (PPOs), identified by the START criteria, and to identify predictors for clinically relevant PIMs and PPOs.MethodsThe STOPP and START criteria were applied on the medication lists of 200 older hip fracture patients, consecutively recruited to a randomized controlled study in 2009. For each identified PIM and/or PPO, the clinical relevance was assessed at the individual level, using medical records from both hospital and primary care as well as data collected in the original study.ResultsA total of 555 PIMs/PPOs were identified in 170 (85%) patients (median age: 85 years, 67% female), 298 (54%) of which, in 141 (71%) patients, were assessed as clinically relevant. A greater proportion of PIMs than PPOs were clinically relevant: 71% (95% CI: 66%; 76%) vs. 32% (27%; 38%). A greater proportion of PPOs than PIMs could not be assessed with available information: 38% (32%; 44%) vs. 22% (17%; 27%). Number of drugs and multidose drug dispensing, but not age, sex, cognition, or nursing home residence, were associated with ≥1 clinically relevant PIMs/PPOs.ConclusionsThe present study illustrates that one in two PIMs/PPOs identified by the STOPP/START criteria is clearly clinically relevant, PIMs being clinically relevant to a greater extent than PPOs. Based on available information, the clinical relevance could not be determined in a non-negligible proportion of PIMs/PPOs. Number of drugs and multidose drug dispensing were associated with ≥1 clinically relevant PIMs/PPOs.

Highlights

Prescribing of drugs is a challenge, in older people who are sensitive to drug effects and often suffer from multiple morbidities
The present study illustrates that one in two potentially inappropriate medications (PIMs)/prescription omissions (PPOs) identified by the STOPP/screening tool to alert to right treatment (START) criteria is clearly clinically relevant, PIMs being clinically relevant to a greater extent than PPOs
The clinical relevance could not be determined in a non-negligible proportion of PIMs/PPOs

Summary

Introduction

Prescribing of drugs is a challenge, in older people who are sensitive to drug effects and often suffer from multiple morbidities It is well-known that suboptimal pharmacotherapy is common in older people, such as treatment with inappropriate drugs or dosages, and/or omissions of drugs which the patient would probably benefit from [1,2,3]. The screening tool of older persons’ potentially inappropriate prescriptions (STOPP) and the screening tool to alert to right treatment (START) criteria belong to the ones requiring clinical information [8]. These criteria have been used in several studies describing drug treatment quality [9, 10]. The original version was developed to be applied in the clinical situation by the attending physician, and provide 65 criteria for potentially inappropriate drugs and 22 criteria for potentially missing

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