STOPP/START Leads to Reduction in adverse drug reactions among elderly patients

28 Jul 2016
Professor Denis O’Mahony.

A Health Research Board funded study has shown how a simple intervention, can substantially reduce adverse drug reactions and make significant savings to patient and exchequer medication costs.

STOPP/START (Screening Tool of Older Persons Prescriptions (STOPP) and Screening Tool to Alert to the Right Treatment (START)) was devised and validated in University College Cork for the purpose of detection of common instances of inappropriate prescribing in older people.

The findings, which were published in the Journal of the American Geriatrics Society study, involved 732 patients in Cork University Hospital and showed that the adverse drug reaction (ADR) rate dropped from 24% in the control group to 12.5% in the intervention group. The trial also saw a significantly lower cost of medication amongst those patients who received the intervention’. The study was a single-blind cluster, randomised controlled clinical trial of unselected older patients hospitalised over a 13-month period. From a consecutive sample of 1042 patients aged over 65 years, 732 were enrolled on the trial with 372 receiving standard care and 360 receiving the STOPP/START intervention.

Commenting on the research, Graham Love, Chief Executive at the Health Research Board, stated that  “This is a brilliant result all round. In a nutshell the research has demonstrated that the STOPP/START intervention is easy to apply, cheap, good for patients and reduces costs. This is a significant finding. Not only did Professor Denis O’Mahony and his team come up with this intervention in the first place, but they have been at the forefront of quality research to demonstrate its effectiveness. Their intervention is also being used as the basis for a number of other EU research projects. This clearly demonstrates the impact that quality research can have on improving health services and reducing costs in Ireland and beyond.”

Professor Denis O’Mahony, a Consultant Geriatrician at Cork University Hospital and senior clinical lecturer from University College Corks School of Medicine, states that “this specific study demonstrated that a one-time application of the STOPP/START criteria can significantly reduce adverse drug reactions in elderly patients admitted to hospital. We have seen how the STOPP and START criteria have been designed and validated for the purpose of highlighting potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) in older people. The intervention involves a systematic structured review of medications conducted by a clinically trained person. The results are communicated to the patients attending medical team who make the final clinical decision on whether to implement the indicated medication changes. The fundamental aim of STOPP criteria is to minimize medication-related adversity by highlighting and avoiding PIMs. The complimentary aim of START criteria is to minimize avoidable therapeutic errors by highlighting PPOs and encouraging appropriate prescriptions where they are absent for no sound clinical reason.”

Professor O’Mahony also commented that “We are really excited by these findings and we think that the HSE, Department of Health, Pharmacists and Clinicians should look at how best to apply this intervention in both acute and primary care settings. It could make a significant impact to lower potentially inappropriate medications and potential prescribing omissions, as well as drive down pharmaceutical costs to the State.”

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