International Journal of Clinical Pharmacy

, Volume 41, Issue 6, pp 1562–1569 | Cite as

Patients’ clinical information requirements to apply the STOPP/START criteria

  • Rosário Carvalho
  • Marta Lavrador
  • Ana C. Cabral
  • Manuel T. Veríssimo
  • Isabel V. Figueiredo
  • Fernando Fernandez-Llimos
  • M. Margarida Castel-BrancoEmail author
Research Article


Background The STOPP/START criteria are an explicit tool to detect potentially inappropriate medications (PIMs). Patient clinical information may not be available in all settings. Objective To identify patient clinical information needed to apply the STOPP/START criteria. Setting: Four nursing homes in Portugal. Methods First, a theoretical analysis was performed to identify the patient information required to apply the STOPP/START criteria (v2), according to the following categories: patients’ current medication, medication history (previous medication and duration), medical records (current and past medical conditions), and laboratory test results. A verification of the information requirements was conducted through a cross-sectional study on a nursing home population with patients over 65 years old. Patients’ medical records were appraised to extract only demographic data and current medication profiles. Main outcome measure Information requirements of STOPP/START. Results For only 29 of the 81 STOPP criteria and 1 of the 34 START criteria, a judgement could be made with only the information in the patient’s medication profile. 52 STOPP and 33 START criteria require additional information, (i.e. duration of therapy, previous medication, current and past medical conditions, and laboratory data). The 208 evaluated persons (87 years; 68.75% female) used 1770 medications, with 989 (55.9%) potentially involved in 1629 STOPP criteria. Sufficient information to judge STOPP criteria was available for only 529 (32.5%) potential STOPP criteria situations, with a positive identification of a STOPP PIM in 397 instances (75.0%). Conclusions Although STOPP/START criteria can be considered a high-level tool to identify PIMs, their use may be compromised in scenarios where access to patients’ clinical information is limited.


Aged Clinical patient information Drug safety Inappropriate prescribing STOPP/START criteria 



Marta Lavrador obtained a complete Doctoral grant from the FCT—Fundação para a Ciência e a Tecnologia (SFRH/BD/123678/2016). No other external funding was received for this study.

Conflicts of interest

The authors declare that they have no conflict of interest.

Supplementary material

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Supplementary material 1 (DOCX 20 kb)


  1. 1.
    OECD. Health Statistics. 2019. Accessed 6 Sep 2019.
  2. 2.
    Lucchetti G, Lucchetti AL. Inappropriate prescribing in older persons: a systematic review of medications available in different criteria. Arch Gerontol Geriatr. 2017;68:55–61.CrossRefGoogle Scholar
  3. 3.
    Chang CB, Chan DC. Comparison of published explicit criteria for potentially inappropriate medications in older adults. Drugs Aging. 2010;27(12):947–57.CrossRefGoogle Scholar
  4. 4.
    Santos AP, Silva DT, Alves-Conceicao V, Antoniolli AR, Lyra DP Jr. Conceptualizing and measuring potentially inappropriate drug therapy. J Clin Pharm Ther. 2015;40(2):167–76.CrossRefGoogle Scholar
  5. 5.
    Kaufmann CP, Tremp R, Hersberger KE, Lampert ML. Inappropriate prescribing: a systematic overview of published assessment tools. Eur J Clin Pharmacol. 2014;70(1):1–11.CrossRefGoogle Scholar
  6. 6.
    The 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674–694.Google Scholar
  7. 7.
    Kuhn-Thiel AM, Weiß C, Wehling M; FORTA authors/expert panel members. Consensus validation of the FORTA (Fit fOR The Aged) list: a clinical tool for increasing the appropriateness of pharmacotherapy in the elderly. Drugs Aging. 2014;31(2):131–40.CrossRefGoogle Scholar
  8. 8.
    Renom-Guiteras A, Meyer G, Thurmann PA. The EU(7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries. Eur J Clin Pharmacol. 2015;71(7):861–75.CrossRefGoogle Scholar
  9. 9.
    O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44(2):213–8.CrossRefGoogle Scholar
  10. 10.
    Hill-Taylor B, Walsh KA, Stewart S, Hayden J, Byrne S, Sketris IS. Effectiveness of the STOPP/START (screening tool of older persons’ potentially inappropriate prescriptions/screening tool to alert doctors to the right treatment) criteria: systematic review and meta-analysis of randomized controlled studies. J Clin Pharm Ther. 2016;41(2):158–69.CrossRefGoogle Scholar
  11. 11.
    Ryan C, O’Mahony D, O’Donovan DO, O’Grady E, Weedle P, Kennedy J, Byrne S. A comparison of the application of STOPP/START to patients’ drug lists with and without clinical information. Int J Clin Pharm. 2013;35(2):230–5.CrossRefGoogle Scholar
  12. 12.
    Almeida TA, Reis EA, Pinto IVL, Ceccato M, Silveira MR, Lima MG, Reis AMM. Factors associated with the use of potentially inappropriate medications by older adults in primary health care: an analysis comparing AGS Beers, EU(7)-PIM List, and Brazilian Consensus PIM criteria. Res Social Adm Pharm RSAP. 2018. Scholar
  13. 13.
    Lavrador M, Silva AA, Cabral AC, Caramona MM, Fernandez-Llimos F, Figueiredo IV, Castel-Branco MM. Consequences of ignoring patient diagnoses when using the, 2015 updated beers criteria. Int J Clin Pharm. 2019. Scholar
  14. 14.
    Anrys P, Boland B, Degryse JM, De Lepeleire J, Petrovic M, Marien S, Dalleur O, Strauven G, Foulon V, Spinewine A. STOPP/START version 2-development of software applications: easier said than done? Age Ageing. 2016;45(5):589–92.CrossRefGoogle Scholar
  15. 15.
    Dalton K, O’Brien G, O’Mahony D, Byrne S. Computerised interventions designed to reduce potentially inappropriate prescribing in hospitalised older adults: a systematic review and meta-analysis. Age Ageing. 2018;47(5):670–8.CrossRefGoogle Scholar
  16. 16.
    O’Connor MN, Gallagher P, O’Mahony D. Inappropriate prescribing: criteria, detection and prevention. Drugs Aging. 2012;29(6):437–52.CrossRefGoogle Scholar
  17. 17.
    Meulendijk MC, Spruit MR, Drenth-van Maanen AC, Numans ME, Brinkkemper S, Jansen PA, Knol W. Computerized decision support improves medication review effectiveness: an experiment evaluating the STRIP assistant’s usability. Drugs Aging. 2015;32(6):495–503.CrossRefGoogle Scholar
  18. 18.
    Ryan C, O’Mahony D, Byrne S. Application of STOPP and START criteria: interrater reliability among pharmacists. Annals Pharmacother. 2009;43(7):1239–44.CrossRefGoogle Scholar
  19. 19.
    Gallagher P, Baeyens JP, Topinkova E, Madlova P, Cherubini A, Gasperini B, Cruz-Jentoft A, Montero B, Lang PO, Michel JP, O’Mahony D. 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. 2009;38(5):603–6.CrossRefGoogle Scholar
  20. 20.
    Siripala UGS, Premadasa SPK, Samaranayake NR, Wanigatunge CA. Usefulness of STOPP/START criteria to assess appropriateness of medicines prescribed to older adults in a resource-limited setting. Int J Clin Pharm. 2019. Scholar
  21. 21.
    Butool I, Nazir S, Afridi M, Shah SM. Evaluation and assessment of prescribing patterns in elderly patients using two explicit criteria based screening tools: (The PRISCUS list and STOPP/START criteria). Pak J Med Sci. 2018;34(6):1357–62.CrossRefGoogle Scholar
  22. 22.
    Nauta KJ, Groenhof F, Schuling J, Hugtenburg JG, van Hout HPJ, Haaijer-Ruskamp FM, Denig P. Application of the STOPP/START criteria to a medical record database. Pharmacoepidemiol Drug Saf. 2017;26(10):1242–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Pharmacology and Pharmaceutical Care Laboratory, Faculty of PharmacyUniversity of Coimbra, Azinhaga de Santa CombaCoimbraPortugal
  2. 2.Coimbra Institute for Clinical and Biomedical Research (iCBR)CoimbraPortugal
  3. 3.Faculty of MedicineUniversity of CoimbraCoimbraPortugal
  4. 4.Department of Social Pharmacy, Faculty of PharmacyUniversity of LisbonLisbonPortugal
  5. 5.Institute for Medicines Research (iMed.ULisboa), University of LisbonLisbonPortugal

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