Abstract
Background A European screening tool (STOPP/START) has been formulated to identify the prescribing of potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs). Pharmacists working in community pharmacies could use STOPP/START as a guide to conducting medication use reviews; however, community pharmacists do not routinely have access to patients’ clinical records. Objective To compare the PIM and PPO detection rates from application of the STOPP/START criteria to patients’ medication details alone with the detection rates from application of STOPP/START to information on patients’ medications combined with clinical information. Setting Community Pharmacy. Method Three pharmacists applied STOPP/START to 250 patient medication lists, containing information regarding dose, frequency and duration of treatment. The PIMs and PPOs identified by each pharmacist were compared with those identified by consensus agreement of two other pharmacists, who applied STOPP/START criteria using patients’ full clinical records. Main outcome measure The main outcome measures were: (1) PIM and PPO detection rates among pharmacists with access to patients’ clinical information compared to PIM and PPO detection rates among pharmacists using patients’ medication information only, and (2) the levels of agreement (calculated using Cohen’s kappa statistic (k)) for the three most commonly identified PIMs and PPOs. Results Pharmacists with access to patients’ clinical records identified significantly fewer PIMs than pharmacists without (p = 0.002). The three most commonly identified PIMs were benzodiazepines, proton pump inhibitors and duplicate drug classes, with kappa (k) statistic agreement ranges of 0.87–0.97, 0.60–0.68 and 0.39–0.85 respectively. PPOs were identified more often (p < 0.001) when clinical information was considered. The three most commonly identified PPOs were: bisphosphonates, β2-agonists and anti-platelets, with kappa (k) statistic agreement ranges of 0.89–1.0, 0.50–0.80 and 0.5–1.0 respectively. Conclusions PIM detection is likely to be overestimated using STOPP and PPO detection underestimated using START when STOPP/START is used in isolation of clinical information. Agreement for a selected number of criteria for which clinical information is not required is good, suggesting that some criteria may be reliably deployed without clinical information during a medicines use review. However, for STOPP/START criteria to be deployed more effectively by pharmacists, access to the full clinical record is recommended.
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References
Gallagher P, O’Mahony D. Inappropriate prescribing in older people. Rev Clin Gerontol. 2008;12:65–76.
Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2004;57:6–14.
Milton JC, Hill-Smith I, Jackson SHD. Prescribing for older people. BMJ. 2008;336:606–9.
Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D. STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46:72–83.
Ryan C, O’Mahony D, Kennedy J, Weedle P, Byrne S. Potential inappropriate prescribing in an Irish elderly population in primary care. Br J Clin Pharmacol. 2009;68:936–47.
Gallagher P, O’Mahony D. STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers’ criteria. Age Ageing. 2008;37:673–9.
Barry PJ, Gallagher P, Ryan C, O’Mahony D. START (screening tool to alert doctors to the right treatment)-an evidence-based screening tool to detect prescribing omissions in elderly patients. Age Ageing. 2007;36:632–8.
O’Sullivan D, O’Mahony D, Parsons C, Hughes C, Patterson S, Byrne S. Inappropriate prescribing in Irish nursing homes residents. EGM. 2011;2:S11–2.
Gallagher PF, O’Connor MN, O’Mahony D. Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria. Clin Pharmacol Ther. 2011;89:845–54.
Hamilton H, Gallagher P, Ryan C, Byrne S, O’Mahony D. Potentially inappropriate medications defined by STOPP Criteria and the risk of adverse drug events in older hospitalized patients. Arch Intern Med. 2011;171:1013–9.
Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163(22):2716–24.
National Service Framework for older people. Implementing medicines related aspects of the NSF for older people. London: Department of Health; 2001.
Department of Health. The pharmaceutical services (advanced and enhances services) (England), Amendment directions. 2006. http://www.dh.gov.uk/assetRoot/04/10/75/97/04107597.pdf. Last accessed 29 July 2012.
Ryan C, O’Mahony D, Byrne S. Application of STOPP and START criteria: inter-rater reliability among pharmacists. Ann Pharmacother. 2009;43:1239–44.
Blenkinsopp A, Anderson C, Armstrong M. Systematic review of the effectiveness of community pharmacy-based interventions to reduce risk behaviours and risk factors for coronary heart disease. J Public Health Med. 2003;25:144–53.
Reid F, Murray P, Storrie M. Implementation of a pharmacist-led clinic for hypertensive patients in primary care-a pilot study. Pharm World Sci. 2005;27:202–7.
Zermansky AG, Petty DR, Raynor DK, Freemantle N, Vail A, et al. Randomised controlled trial of clinical medication review by a pharmacist of elderly patients receiving repeat prescriptions in general practice. BMJ. 2001;323:1340–3.
Lenaghan E, Holland R, Brooks A. Home-based medication review in a high risk elderly population in primary care-the POLYMED randomised controlled trial. Age Ageing. 2007;36:292–7.
Laaksonen R, Duggan C, Bates I. Performance of community pharmacists in providing clinical medication reviews. Ann Pharmacother. 2010;44:1181–90.
Krska J, Avery AJ. Evaluation of a medication review conducted by community pharmacists: a quantitative analysis of documented issues and recommendations. Br J Clin Pharmacol. 2007;65:386–96.
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We would like to sincerely thank the community pharmacists who participated in the study.
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Conflicts of interest
Drs O’Mahony, Byrne and Ryan have, in association with University College Cork, participated in a licence agreement for the development of STOPP/START software with Clinical Support Information Systems Ltd., Castletroy, Limerick.
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Ryan, C., O’Mahony, D., O’Donovan, D.Ó. et al. A comparison of the application of STOPP/START to patients’ drug lists with and without clinical information. Int J Clin Pharm 35, 230–235 (2013). https://doi.org/10.1007/s11096-012-9733-0
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DOI: https://doi.org/10.1007/s11096-012-9733-0