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Effectiveness of the STOPP / START (Screening Tool of Older Persons' potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment) criteria: systematic review and meta‐analysis of randomized controlled studies
Author(s) -
HillTaylor B.,
Walsh K. A.,
Stewart S.,
Hayden J.,
Byrne S.,
Sketris I. S.
Publication year - 2016
Publication title -
journal of clinical pharmacy and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.622
H-Index - 73
eISSN - 1365-2710
pISSN - 0269-4727
DOI - 10.1111/jcpt.12372
Subject(s) - medicine , cinahl , randomized controlled trial , medline , medical prescription , systematic review , meta analysis , delirium , study heterogeneity , family medicine , intensive care medicine , emergency medicine , psychological intervention , psychiatry , nursing , political science , law
Summary What is known and objective STOPP / START are explicit screening tools that identify potentially inappropriate prescribing in older adults. Our objective was to update our 2013 systematic review that showed limited evidence of impact, using new evidence from randomized controlled trials ( RCT s) assessing clinical, humanistic and economic outcomes in older adults. Methods We performed a search of PubMed, EMBASE , CINAHL , Web of Science and grey literature for RCT s published in English since the previous review through June 2014. The Cochrane Risk of Bias Tool was used. We performed a meta‐analysis on the effect of STOPP on potentially inappropriate medication ( PIM ) rates and a narrative synthesis on other outcomes. Results and discussion Four RCT s ( n = 1925 adults) from four countries were included, reporting both acute ( n = 2) and long‐term care ( n = 2) patients. Studies differed in implementation. Two studies were judged to have low risk, and two to have moderate‐to‐high risk of bias in key domains. Meta‐analysis found that the STOPP criteria reduced PIM rates in all four studies, but study heterogeneity ( I 2 = 86·7%) prevented the calculation of a meaningful statistical summary. We found evidence that use of the criteria reduces falls, delirium episodes, hospital length‐of‐stay, care visits (primary and emergency) and medication costs, but no evidence of improvements in quality of life or mortality. What is new and conclusion STOPP / START may be effective in improving prescribing quality, clinical, humanistic and economic outcomes. Additional research investigating these tools is needed, especially in frail elderly and community‐living patients receiving primary care.