Inappropriate prescribing according to the STOPP/START criteria in older people from a primary care setting

Abstract

Background: STOPP (screening tool of older persons’ prescriptions)/START (screening tool to alert doctors to right treatment) criteria aim to identify potentially inappropriate medication (PIM) due to mis-, over- and under-prescription in older patients. Initially developed by Irish experts, their applicability has been demonstrated in primary health care (PHC).

Objective: To quantify and identify the most frequent PIM at PHC level using STOPP/START criteria. To identify factors that may modulate the onset of PIM.

Methods: Audit of a random sample of 272 electronic health records (including prescription, diagnosis and laboratory results) of patients ≥ 65 years old, with at least one prescription in the last three months, from a PHC setting in the Vigo Health Authority (Spain). Original STOPP/START criteria were used, as well as a version adapted to Spanish PHC. Descriptive statistics and generalized linear models were applied.

Results: The median number of medicines per patient was 5 (inter-quartile range: 3–7). The prevalence of PIM identified by the STOPP criteria was 37.5% and 50.7%, with the original criteria and the Spanish version, respectively. Using both versions of the START tool, the prevalence of under-prescription was 45.9% and 43.0%, respectively. A significant correlation was found between the number of STOPP PIM and number of prescriptions, and between the number of START PIM with Charlson comorbidity index and number of prescriptions. Of 87 criteria, 20 accounted for 80% of PIM.

Conclusion: According to STOPP/START criteria, there is a high level of PIM in PHC setting. To prevent PIM occurring, action must be taken.

Keywords::

• Inappropriate prescribing
• aged
• primary health care
• STOPP/START criteria
• patient safety

FUNDING

The study received a grant from the Spanish Ministry of Health and Consumer Affairs in public competition, reference number EC 10/172.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.