Effectiveness of STOPP/START Criteria in Primary Prevention of Polypharmacy and Under-treatment in Older Patients

Emi̇n Pala, Süleyman Ersoy, Velittin Selçuk Engin, Ali Ramazan Benli

Keywords: STOPP/START criteria, Rational drug use, Primary care, Polypharmacy, Under-treatment

Background:
STOPP/START criteria appear to be a useful tool to curb inappropriate prescribing (IP), which encompasses errors of both, over and under-treatment. This study aimed to find out whether application of STOPP/START reduces the IP effectively in primary care.

Research questions:

Method:
This prospective cross-sectional study was conducted in two family health centers (FHC) in Istanbul. All older adults who applied to FHCs between 01-07-2018 and 01-07-2020 were enrolled. The potential inappropriate medications (PIMs) and potential prescription omissions (PPOs) were identified according to STOPP/START version 2 criteria. Mean drug consumptions before and after STOPP/START were compared using Student’s t-test.

Results:
Among 1023 participants there were 626 females and 397 males. The mean age was 73.33±7.30 years. The number of the patients seen at FHCs was 657(64.2%) while 366(35.8%) of them were visited at home. Of the patients, 383(37.8) were 75 years old or older and 631(62.2%) of them were under 75. Overall number of drugs consumed per patient was 5.49±3.93 while it was 6.01±3.71 and 4.55±4.138 for outpatients and home patients respectively (p<0.001). By application of STOPP criteria, among the 5616 medications consumed by the overall patients, 881(%15.6) of them were found to be potentially inappropriate. 424 (41.4%) patients were using at least one PIM. This ratio was 354 (53.8 %) in outpatients and 70 (19%) in home patients. START criteria identified 380 (%7.4) PPOs. There were 246 (24.0%) patients with at least with one PPO; 155 (42.3%) of whom were home patient and 91 (13.8%) were outpatients. Regarding the age groups; PIM ratio was 35.5% in patients under 75 and 52.1% over 75whereas PPO ratio was 22.5% under 75 and 26.8% over 75.

Conclusions:
This study supports the data reporting the effectiveness of STOPP/START criteria in primary care units in implementing appropriate prescription criteria.

Points for discussion: