Advertisement

European Journal of Clinical Pharmacology

, Volume 74, Issue 3, pp 331–338 | Cite as

Inter-rater reliability of STOPPFrail [Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy] criteria amongst 12 physicians

  • Amanda Hanora LavanEmail author
  • Paul Gallagher
  • Denis O’Mahony
Pharmacoepidemiology and Prescription

Abstract

Purpose

STOPPFrail is an explicit tool, developed by Delphi consensus, to assist physicians with deprescribing medications in frail older adults with poor survival prognosis. This study aimed to determine the inter-rater reliability (IRR), amongst physicians, of STOPPFrail application.

Methods

Twenty clinical cases were collated to represent frail older patients. Eighteen cases met STOPPFrail inclusion criteria. They had a mean age of 79.5 (SD6) years and a median of 7 (IQR6–8.25) comorbidities and were prescribed a median of 9 (IQR7.75–11.25) medications. Two of the STOPPFrail originators reached complete agreement (gold standard) in determining 91 of 165 medications (55.2%) as inappropriate. Twelve physicians (6 geriatricians, 3 general practitioners and 3 palliative care physicians) independently applied STOPPFrail criteria. IRR between physicians and gold standard (GS) assessment was determined using Cohen’s kappa statistic.

Results

Eighteen of the 20 cases that met STOPPFrail inclusion criteria were correctly identified by 9 of 12 physicians (75%). The average time taken per clinical case was 2.7 (SD0.94) minutes. The kappa co-efficient between physicians and GS assessment ranged from 0.71 (substantial) to 0.86 (good), with a mean kappa value of 0.758 (SD0.059). The Fleiss kappa coefficients between GS assessment and geriatricians, GPs and palliative care physicians were 0.80 (SD0.6), 0.77 (SD0.9) and 0.75 (SD0.1), respectively. No significant difference was noted, between groups or between participants within groups, as determined by one-way ANOVA, (df (2, 9) = 0.712, p = 0.516).

Conclusions

IRR of STOPPFrail criteria between physicians, practising in different specialties, is substantial, despite no prior knowledge of the criteria.

Keywords

Deprescribing Explicit prescribing criteria Inappropriate prescribing Limited life expectancy Frail 

Notes

Acknowledgements

Health Research Board Clinical Research Facilities at University College, Cork (HRB CRF-C), is acknowledged. We would also like to acknowledge the physicians who participated in this study, without whom this research would not be possible (listed alphabetically):

Dr. Katie Boyle, General Practitioner, Cork City Medical Centre, 91 Patrick Street, Cork

Dr. Mary Buckley, Specialist Registrar in Geriatric Medicine, Department of Geriatric Medicine, Mercy University Hospital, Cork

Dr. Bart Daly, Specialist Registrar in Geriatric Medicine, Department of Geriatric Medicine, Cork University hospital, Cork

Dr. Tim Dukelow, Specialist Registrar in Geriatric Medicines, Department of Geriatric Medicine, Mercy University Hospital, Cork

Dr. Norma Harnedy, Consultant Geriatrician, Department of Geriatric Medicine, Cork University Hospital, Cork

Dr. Liam Healy, Consultant Geriatrician, Department of Geriatric Medicine, Cork University Hospital, Cork

Dr. Coman Hennelly, Specialist Registrar in Palliative Medicine, Marymount University Hospital & Hospice & Cork University Hospital, Cork

Dr. Fiona Kiely, Consultant Physician in Palliative Medicine, Marymount University Hospital & Hospice & Cork University Hospital, Cork

Dr. Marie Murphy, Consultant Physician in Palliative Medicine, Marymount University Hospital & Hospice & South Infirmary-Victoria University Hospital & Mercy University Hospital, Cork

Dr. Sadhbh Ní Lionáird, General Practitioner, Meadow Park surgery, Ballyvolane, Cork

Dr. Rónán O’Caoimh, Senior Lecturer in Geriatric Medicine & Consultant Geriatrician, National University of Ireland Galway & University Hospital, Galway

Dr. Denis O’Donovan, trainee GP, Cork Specialist training Scheme in General Practice

Funding information

This research has been funded as part of the SENATOR project funded by the European Union’s Seventh Framework Program (EU FP7) programme (grant number 305930).

Supplementary material

228_2017_2376_MOESM1_ESM.docx (42 kb)
ESM 1 (DOCX 41 kb)

References

  1. 1.
    Heppenstall CP, Broad JB, Boyd M, Hikaka J, Zhang X, Kennedy J, Connolly MJ (2016) Medication use and potentially inappropriate medications in those with limited prognosis living in residential aged care. Australas J Ageing 35(2):E18–E24.  https://doi.org/10.1111/ajag.12220. CrossRefPubMedGoogle Scholar
  2. 2.
    Toscani F, Di Giulio P, Villani D, Giunco F, Brunelli C, Gentile S, Finetti S, Charrier L, Monti M, Van der Steen JT (2013) Treatments and prescriptions in advanced dementia patients residing in long-term care institutions and at home. J Palliat Med 16(1):31–37.  https://doi.org/10.1089/jpm.2012.0165. CrossRefPubMedGoogle Scholar
  3. 3.
    Tosato M, Landi F, Martone AM, Cherubini A, Corsonello A, Volpato S, Bernabei R, Onder G (2014) Potentially inappropriate drug use among hospitalised older adults: results from the CRIME study. Age Ageing 43(6):767–773.  https://doi.org/10.1093/ageing/afu029. CrossRefPubMedGoogle Scholar
  4. 4.
    Hyttinen V, Jyrkka J, Valtonen HA (2016) Systematic review of the impact of potentially inappropriate medication on health care utilization and costs among older adults. Med Care 54(10):950–964.  https://doi.org/10.1097/mlr.0000000000000587. CrossRefPubMedGoogle Scholar
  5. 5.
    Chiatti C, Bustacchini S, Furneri G, Mantovani L, Cristiani M, Misuraca C, Lattanzio F (2012) The economic burden of inappropriate drug prescribing, lack of adherence and compliance, adverse drug events in older people: a systematic review. Drug Saf 35(Suppl 1):73–87.  https://doi.org/10.1007/bf03319105 CrossRefPubMedGoogle Scholar
  6. 6.
    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol Ser A Biol Sci Med Sci 56(3):M146–M156CrossRefGoogle Scholar
  7. 7.
    Stevenson J, Abernethy AP, Miller C, Currow DC (2004) Managing comorbidities in patients at the end of life. BMJ 329(7471):909–912.  https://doi.org/10.1136/bmj.329.7471.909. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Palagyi A, Keay L, Harper J, Potter J, Lindley RI (2016) Barricades and brickwalls—a qualitative study exploring perceptions of medication use and deprescribing in long-term care. BMC Geriatr 16(1):1–11.  https://doi.org/10.1186/s12877-016-0181-x. CrossRefGoogle Scholar
  9. 9.
    Harriman K, Howard L, McCracken R (2014) Deprescribing medication for frail elderly patients in nursing homes: a survey of Vancouver family physicians. British Columbia Med J 56(9)Google Scholar
  10. 10.
    Schuling J, Gebben H, Veehof LJG, Haaijer-Ruskamp FM (2012) Deprescribing medication in very elderly patients with multimorbidity: the view of Dutch GPs. A qualitative study. BMC Fam Pract 13(1):56.  https://doi.org/10.1186/1471-2296-13-56. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Matlow JN, Bronskill SE, Gruneir A, Bell CM, Stall NM, Herrmann N, Seitz DP, Gill SS, Austin PC, Fischer HD, Fung K, Wu W, Rochon PA (2017) Use of medications of questionable benefit at the end of life in nursing home residents with advanced dementia. J Am Geriatr Soc 65(7):1535–1542.  https://doi.org/10.1111/jgs.14844 CrossRefPubMedGoogle Scholar
  12. 12.
    Lavan AH, Gallagher P, Parsons C, O'Mahony D (2017) STOPPFrail [screening tool of older persons prescriptions in frail adults with limited life expectancy]: consensus validation. Age Ageing 46(5):875.  https://doi.org/10.1093/ageing/afx005. CrossRefPubMedGoogle Scholar
  13. 13.
    Drenth-van Maanen AC, Spee J, van Hensbergen L, Jansen PA, Egberts TC, van Marum RJ (2011) Structured history taking of medication use reveals iatrogenic harm due to discrepancies in medication histories in hospital and pharmacy records. J Am Geriatr Soc 59(10):1976–1977.  https://doi.org/10.1111/j.1532-5415.2011.03610_11.x CrossRefPubMedGoogle Scholar
  14. 14.
    Cantor AB (1996) Sample size calculations for Cohen’s Kappa. Psychol Methods 1(2):150–153.  https://doi.org/10.1037/1082-989X.1.2.150 CrossRefGoogle Scholar
  15. 15.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174.  https://doi.org/10.2307/2529310 CrossRefPubMedGoogle Scholar
  16. 16.
    Gallagher P, Baeyens JP, Topinkova E, Madlova P, Cherubini A, Gasperini B, Cruz-Jentoft A, Montero B, Lang PO, Michel JP (2009) Inter-rater reliability of STOPP (Screening Tool of Older Persons’ Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) criteria amongst physicians in six European countries. Age Ageing 38(5):603–606.  https://doi.org/10.1093/ageing/afp058 CrossRefPubMedGoogle Scholar
  17. 17.
    Majeed A, Car J, Sheikh A (2008) Accuracy and completeness of electronic patient records in primary care. Fam Pract 25(4):213–214.  https://doi.org/10.1093/fampra/cmn047 CrossRefPubMedGoogle Scholar
  18. 18.
    Lau HS, Florax C, Porsius AJ, De Boer A (2000) The completeness of medication histories in hospital medical records of patients admitted to general internal medicine wards. Br J Clin Pharmacol 49(6):597–603CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    AGS 2015 Beers Criteria Update Expert Panel (2015) American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 63(11):2227–2246.  https://doi.org/10.1111/jgs.13702 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Amanda Hanora Lavan
    • 1
    • 2
    Email author
  • Paul Gallagher
    • 1
    • 2
  • Denis O’Mahony
    • 1
    • 2
  1. 1.Department of Geriatric MedicineCork University HospitalCorkIreland
  2. 2.Department of MedicineUniversity College CorkCorkIreland

Personalised recommendations