Views of general practitioners on the use of STOPP&START in primary care: a qualitative study

Abstract

Background and objective:

STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment) criteria aim at detecting potentially inappropriate prescribing in older people. The objective was to explore general practitioners’ (GPs) perceptions regarding the use of the STOPP&START tool in their practice.

Design:

We conducted three focus groups which were conveniently sampled. Vignettes with clinical cases were provided for discussion as well as a full version of the STOPP&START tool. Knowledge, strengths and weaknesses of the tool and its implementation were discussed. Two researchers independently performed content analysis, classifying quotes and creating new categories for emerging themes.

Results:

Discussions highlighted incentives (e.g. systematic procedure for medication review) and barriers (e.g. time-consuming application) influencing the use of STOPP&START in primary care. Usefulness, comprehensiveness, and relevance of the tool were also questioned. Another important category emerging from the content analysis was the projected use of the tool. The GPs imagined key elements for the implementation in daily practice: computerized clinical decision support system, education, and multidisciplinary collaborations, especially at care transitions and in nursing homes.

Conclusion:

Despite variables views on the usefulness, comprehensiveness, and relevance of STOPP&START, GPs suggest the implementation of this tool in primary care within computerized clinical decision support systems, through education, and used as part of multidisciplinary collaborations.

Keywords:

• Appropriateness of prescribing
• Older patients
• STOPP&START
• Primary care

Acknowledgements

The authors thank Luc Erpicum and Alberto Parada for their role as moderator, Nathalie Gillard as observer of the third FG, Vincent Momin and Charlotte Godefroit for the advices on the discussion guide for the FGs, Barbara Sneyers for her advice, Martina Di Marco and Adrien Frenay for the processing of the data, and Martin McGarry for help with translation of quotes from French. We thank all the participants of the FG and the brainstorming. We thank the Belgian Scientific Society of General Practice (Société Scientifique de Médecine Générale, SSMG) and the Centre Académique de Médecine Générale for facilitating the recruitment of participants.