The current study involved a multidisciplinary consensus and validation procedure in order to develop a specification of stoppstart criteria version 2, encoded with international disease and medication classification codes, ultimately providing implementable coded algorithms for software applications. This involved achieving consensus among a group of 18 experts in geriatric medicine, clinical pharmacology, clinical pharmacy, old age psychiatry and primary care. Start criteria screening tool to alert doctors to the right treatment highlight underprescription or omission of. Indeed, stoppstart criteria have limited applicability in this cohort.
Consensus validation older people experience more concurrent. Explicit criteria as clinical tools to minimize inappropriate medication. Stoppfrail screening tool of older persons prescriptions in frail adults with limited life expectancy stoppfrail is a list of criteria for potentially inappropriate medicine use in frail older adults with limited life expectancy. For instance patients with limited life expectancy would be unlikely to survive long enough to derive benefit from most medication listed in the start criteria. Besides this, although the start stopp criteria provide a useful tool for detecting inappropriate drug. Stoppstart are explicit screening tools that identify potentially inappropriate prescribing in older adults. The stopp start screening software is a tool developed as part of this project which takes as input patient cases and prescription histories via gui input or data file and first examines them for stopp rule violations. Request pdf stopp screening tool of older persons prescriptions and start screening tool to alert doctors to right treatment. This can sometimes lead to harm rather than benefit from a. The stoppstart criteria appear to be more sensitive than the 2002 version of the beers. The current study involved a multidisciplinary consensus and validation procedure in order to develop a specification of stopp start criteria version 2, encoded with international disease and medication classification codes, ultimately providing implementable coded algorithms for software applications. Participants a panel of medication management experts were identified consisting of. The purpose of this study was to detect older patients who were prescribed inappropriate drugs, according to startstopp criteria, in their primary care.
Identifying pip is necessary to improve prescribing quality. A delphi consensus technique was used to establish the content validity of stoppstart. Medication errors and screening tool of older persons potentially. The interrater reliability of stoppstart criteria was subsequently established, with high levels of reliability between physicians 6 and also between pharmacists 7. Each general practitioner completed a qualitative post service evaluation interview to determine the acceptability of stopp and. This can sometimes lead to harm rather than benefit from a particular treatment. An 18member expert panel from academic centers in ireland and the united kingdom completed two rounds of the delphi process by mail survey. Stopp and screening tool to alert to right treatment start for detection of potential. Potentially inappropriate prescribing ip is an issue of major importance in the pharmacotherapy of older people globally.
Potentially inappropriate prescribing prevalence studies using stoppstart criteria using the validated and reliable stoppstart criteria, our. A delphi consensus technique was used to establish the content validity of stopp start. A new approach to detecting potentially inappropriate prescribing in old age, authordenis omahony and paul gallagher and cris ryan and stephen byrne and hilary j. Both implementation rates of stopp and start recommendations were lower compared to recommendations not associated with stopp start criteria 66 %, p 0. Validation of prescribing appropriateness criteria for. Validation method intended population disadvantages panel list 8 2007 delphi consensus. Development and validation of the rasp list rationalization of medication by an adjusted stopp list in older patients. The stopp and start criteria were subsequently validated using a delphi consensus methodology in 2006. Conversion of stoppstart version 2 into coded algorithms. Stoppstart version 2 criteria have been expanded and updated for the purpose of minimizing inappropriate prescribing in older people.
Pdf stoppstart criteria for potentially inappropriate. Therefore, as a result of increasing age and frailty, some treatments may cause more harm than benefit. Screening tool of older persons potentially inappropriate prescriptionsscreening tool to alert doctors to right treatment stoppstart and beers criteria were. Conclusions this study shows that the majority of drugrelated problems of communitydwelling older patients was not associated with stoppstart criteria. Conversion of stoppstart version 2 into coded algorithms for. Potentially inappropriate prescribing according to the. These events are potentially preventable up to 50 percent of the time. Potentially inappropriate prescribing pip in longterm. The studies on inappropriate drug use have produced various results.
Stopp screening tool of older persons prescriptions and start screening tool to alert doctors to right treatment. Multimorbidity and polypharmacy represent a major problem for elderly patients. Participants a panel of medication management experts. For the first expert panel consultation, there was a list of 8 proposed stoppstart criteria for evaluation. Dec 11, 2015 the aim of this study was to demonstrate the prevalence and possible predictors of potentially inappropriate medications pims and potentially prescription omissions ppos according to the screening tool of older persons prescriptions stopp and screening tool to alert doctors to right treatment start criteria in geriatric patients. They were originally proposed in 2008 and were updated in 2014. Fifteen of the criteria from stoppstart version 1 were not included in stoppstart version 2 table table1 1 on the basis of a lack of sufficiently robust or consistent evidence in the published literature. The delphi method was used for this research because of the lack of rigorous randomised controlled evidence supporting the longterm bene. The stoppstart screening software is a tool developed as part of this project which takes as input patient cases and prescription histories via gui input or data file and first examines them for stopp rule violations. Interrater reliability was assessed by determining the kappastatistic for measure of agreement on 100 data. Patients aged over 65, admitted to health center no. Adverse drug events were defined by world health organizationuppsala monitoring centre criteria and verified by a local expert consensus panel, which also assessed whether ades were causal or contributory to current hospitalization.
Older people are known to be at greater risk of adverse effects from their medicines due to age related changes in pharmacokinetics and pharmacodynamics. Adverse drug events occur in 15 percent or more of older patients presenting to offices, hospitals, and extended care facilities. Stopp screening tool of older persons prescriptions and. While the individual recommendations from a guideline may be.
Potentially inappropriate medications defined by stopp. Potentially inappropriate medicines were defined by both beers and stopp criteria. The aim of this study was to perform expert consensus validation of the forta fit for the aged list, a drug classification combining positive and negative labelling of drugs chronically. Stopp start are explicit screening tools that identify potentially inappropriate prescribing in older adults. Stoppstart criteriafor potentially inappropriate prescribing.
Reducing the risk of adverse drug events in older adults. Jun 12, 20 on the other hand, start is a list of 22 rules related to common instances of prescribing omissions for older people. Stoppstart consensus panel of 18 experts delphi process 2 rounds final agreed list of stopp criteria n65 and start n22 good inter. To date, stoppstart criteria have been tested as an intervention in four rcts. The aim of this study was to perform expert consensus validation of the forta fit for the aged list, a drug classification combining positive and. Screening tool of older persons potentially inappropriate prescriptionsscreening tool to alert doctors to right treatment stoppstart and beers.
However, beers criteria have a number of serious flaws and are of doubtful relevance to routine geriatric pharmacotherapy. Stoppstart criteria for potentially inappropriate prescribing in. The full text of this article is available in pdf format. Table table2 2 details those criteria rejected during the delphi consensus validation of stopp start version 2. The use of stoppstart to screen and address imu in europe, asia, north america, south america, africa and australia suggests that the criteria have global relevance. The files of the subjects were surveyed retrospectively for the final one year in the digital environment, using the family medicine information system. Gallagher p, ryan c, byrne s, kennedy j, omahony d. Beers list are considered to be potentially useful.
We have recently shown that stoppstart criteria as an intervention significantly improves medication. A new version of the stoppstart criteria, a new step. Objective to further develop and validate previously published national prescribing appropriateness criteria to assist in identifying drugrelated problems drps for commonly occurring medications and medical conditions in older. Screening tools for geriatric medicine prescription. Potentially inappropriate prescribing pip in longterm care. Stopp start version 2 criteria have been expanded and updated for the purpose of minimizing inappropriate prescribing in older people. The modified stopp start criteria for sri lanka consisted of 105 criteria, including 70 stopp criteria and 35 start criteria after two delphi validation rounds and a final meeting held with the participation of all experts to resolve disagreements and to establish 100% consensus.
An early prevalidation pilot study of hospitalised older patients in cork. Oct 16, 2014 fifteen of the criteria from stopp start version 1 were not included in stopp start version 2 table table1 1 on the basis of a lack of sufficiently robust or consistent evidence in the published literature. Table table2 2 details those criteria rejected during the delphi consensus validation of stoppstart version 2. Potentially inappropriate prescribing according to the stopp. Conclusions this study shows that the majority of drugrelated problems of communitydwelling older patients was not associated with stopp start criteria. Clinical guideline not to replace expert knowledge. It is designed to assist physicians with stopping such medication in older patients. Population demographics are changing globally, with the greatest proportional increases seen in those aged. The modified stoppstart criteria for sri lanka consisted of 105 criteria, including 70 stopp criteria and 35 start criteria after two delphi validation rounds and a final meeting held with the participation of all experts to resolve disagreements and to. The use of startstopp criteria for elderly patients in. The aim of this study was to demonstrate the prevalence and possible predictors of potentially inappropriate medications pims and potentially prescription omissions ppos according to the screening tool of older persons prescriptions stopp and screening tool to alert doctors to right treatment start criteria in geriatric patients.
Both implementation rates of stopp and start recommendations were lower compared to recommendations not associated with stoppstart criteria 66 %, p 0. To date, beers criteria have been in common research usage for defining potentially inappropriate medications pims in older people. Many older people are surviving longer with complex comorbid illnesses including dementia, chronic kidney disease, cardiovascular disease, chronic lung disease and cancer, many of which contribute to frailty and poor survival prognosis 2, 3. The stopp start criteria, developed and validated in 2003, are the most recent tool used for the same purpose. The remaining 17 criteria 7 stopp and 10 start criteria formed the basis for delphi consensus round 2 which achieved consensus on 7 criteria. Dec 19, 20 multimorbidity and polypharmacy represent a major problem for elderly patients. Introduction potentially inappropriate prescribing pip is frequent and problematic in older patients. Objectives to analyse the applicability of the stoppstart criteria as a tool to identify patients with potentially inappropriate medications pim during pharmaceutical validation of prescriptions in a longterm care hospital, to identify risk factors for pim and to characterise the physiological systems and drugs more frequently associated with these pim. Start screening tool to alert doctors to the right treatment an evidence based screening tool to detect prescribing omissions in elderly patients. Indeed, stopp start criteria have limited applicability in this cohort. Stopp screening tool of older persons potentially inappropriate prescriptions 2008, ireland, consensus techniques aged. Observational studies have reported the prevalence and predictors of pip. Explicit and implicit checklists and possible tools. Validation of prescribing appropriateness criteria for older.
P gallagher, c ryan, s byrne, j kennedy, d omahony international journal of clinical pharmacology and therapeutics 2008, 46 2. The construction and validation process of stopp start version 2 is summarised as follows. Consensus validation int j clin pharmacol ther 2008. Explicit criteria as clinical tools to minimize inappropriate. Refinement of stoppstart criteria evidence base delphi validation of stoppstart criteria and preparation of manuscript for publicatio. These included the original 87 stoppstart version 1 criteria plus 37 possible additional criteria proposed by the irish stoppstart criteria group. Stoppfrail screening tool of older persons prescriptions. Stoppfrail screening tool of older persons prescriptions in. There was limited evidence that the application of stoppstart criteria. Effectiveness of the stoppstart screening tool of older. Consensus was easily reached in the selection of included. The modified stoppstart criteria for sri lanka consisted of 105 criteria, including 70 stopp criteria and 35 start criteria after two delphi validation rounds and a final meeting held with the participation of all experts to resolve disagreements and to establish 100% consensus.