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.
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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).
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Lavan, A.H., Gallagher, P. & O’Mahony, D. Inter-rater reliability of STOPPFrail [Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy] criteria amongst 12 physicians. Eur J Clin Pharmacol 74, 331–338 (2018). https://doi.org/10.1007/s00228-017-2376-2
- Explicit prescribing criteria
- Inappropriate prescribing
- Limited life expectancy