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



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.


Deprescribing 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

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)


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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

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