STOPP/START criteria for potentially inappropriate medications/potential prescribing omissions in older people: origin and progress

ABSTRACT

Introduction: STOPP (Screening Tool of Older Persons’ Prescriptions) and START (Screening Tool to Alert to Right Treatment) are explicit criteria that facilitate medication review in multi-morbid older people in most clinical settings. This review examines the clinical trial evidence pertaining to STOPP/START criteria as an intervention.

Areas covered: The literature was searched for registered clinical trials that used STOPP/START criteria as an intervention. In single-center trials, applying STOPP/START criteria improved medication appropriateness, reduced polypharmacy, reduced adverse drug reactions (ADRs), led to fewer falls, and lower medication costs. Two large-scale multi-center trials (SENATOR and OPERAM) examined the impact of computer-generated STOPP/START criteria on incident ADRs (SENATOR) and drug-related hospitalizations (OPERAM) in multi-morbid older people. Results of these trials will be publicized in 2020.

Expert opinion: Applying STOPP/START criteria improves clinical outcomes in multi-morbid older people. Electronic deployment of STOPP/START criteria is a substantial technical challenge; however, recent clinical trials of software prototypes demonstrate feasibility. Even with well-functioning software for the application of STOPP/START criteria, the need remains for face-to-face interaction between attending clinicians and appropriately trained personnel (likely pharmacists) to explain and qualify specific STOPP/START recommendations in individual multi-morbid older patients. Such interaction is essential for the implementation of relevant STOPP/START recommendations.

KEYWORDS:

• Adverse drug event
• adverse drug reaction
• elderly
• hospital
• inappropriate prescribing
• nursing home
• patient safety
• prevention
• primary care
• STOPP/START criteria

Article highlights

• Inappropriate prescribing (IP) is highly prevalent among older people in all clinical settings who experience multi-morbid illness which inevitably leads to polypharmacy.

• STOPP/START explicit IP criteria are designed to detect common and/or important potentially inappropriate medications (PIMs – STOPP criteria) and potential prescribing omissions (PPOs – START criteria).

• Five single-center clinical trials show that application of STOPP/START criteria significantly improves medication appropriateness, reduces medication cost, reduces falls, and diminishes incident adverse drug reactions (ADRs).

• Two large-scale multi-center trials (SENATOR and OPERAM) examining the impact of software-generated STOPP/START criteria on incident ADRs and drug-related hospitalizations will report their findings in 2020.

Declaration of interest

D O’Mahony discloses being the co-ordinator of the SENATOR project and being the co-principal investigator of the OPERAM project. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.