Inter-rater reliability of STOPPFrail [Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy] criteria amongst 12 physicians
- 382 Downloads
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.
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.
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).
IRR of STOPPFrail criteria between physicians, practising in different specialties, is substantial, despite no prior knowledge of the criteria.
KeywordsDeprescribing Explicit prescribing criteria Inappropriate prescribing Limited life expectancy Frail
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
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).
- 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.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
- 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
- 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
- 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
- 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
- 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