APPLICATION OF THE START-STOPP CRITERIA ON AN ELDERLY POPULATION IN BELGIAN GENERAL PRACTICE: an explorative studyJ. Landa 1, A. Torsin 1, T. Cornelissen 1, J. De Lepeleire 2, V. Foulon 3

1General practice, Belgium; 2 Department of General Practice, Katholieke Universiteit , K.U.Leuven, Belgium; 3Research Centre for Pharmaceutical Care and Pharmaco-economics, K.U.Leuven, Belgium

 BACKGROUND AND OBJECTIVE

DISCUSSION AND CONCLUSION

METHODS

START – STOPP CRITERIA

RESULTSPRACTICE AND POPULATION CHARACTERISTICS

Table 1 shows the characteristics of the different general practices. From each practice, 30 files were included. The mean age of the included population was 75 years (range 65-95). Gender was equally distributed.

Table 1: Practice characteristics

START (Screening Tool to Alert doctors to Right Treatment) and STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions) are two validated tools for evaluation of medication appropriateness in the elderly (1).The aim of this study was to examine the feasibility of these criteria in Belgian general practice and to evaluate the changes as proposed by these tools for a selection of medication profiles.

1

•Random selection of medical files of patients aged 65 or more from three different general practices in Belgium.

2

•Review of selected files for non-institutionalized elderly, having 5 or more medications for chronic conditions

3

•Extraction of medication profiles and medical history from the electronic medical records

4

•Application of the START-STOPP criteria.

5

•Qualitative and quantitative evaluation of the proposed medication changes.

Practice 01 Practice 02 Practice 03

Total population 6182 6272 3672

Listed patients (2009-2010) 1505 1500 1307

Listed patients aged > 65 159 309 430

Number of files reviewed 93 37 61

Number of files included 30 30 30

GP’s / practice 3 3 1

EMDF system Windoc HealthOne Medidoc

Practice experience (years) 28 17 34

A total of 705 medications were prescribed for the 90 included patients (average: 7.8). According to the START-STOPP criteria, adjustment of medication would be necessary in 67.8% of the study population, which would reduce the average number of medications taken to 7.4 per patient (Table 4). Application of the START criteria would result in the administration of 0.45 new medications per patient (range 0-2). When using the STOPP criteria a mean number of 0.94 medications could be stopped (range 0-6).

Table 4: mean number of medications per patient

The most important medications that should be started were acetylsalicylic acid and statins. 60% of the medications that should be stopped were medications used for nervous system disorders. 97% of those were benzodiazepines.

FEASIBILITY

It took on average 20 minutes per file to extract the necessary information (i.e. medication list, active problem list, biochemistry) from the EMDF and put them in an Excel sheet.The mean time needed to apply the START-STOPP criteria on a medical file was 4.5 minutes.

Before START/STOPP

After START/STOPP

Practice 1 6,8 6,5

Practice 2 8,3 7,4

Practice 3 8,4 8,2

Mean 7.8 7.4

The START-STOPP criteria are a valuable tool for the medication management of elderly patients and can be used by the general practitioner. A well organized electronic medical record is indispensible for this. At anytime, application of the criteria has to be accompanied by good clinical thinking of the treating doctor. Deliberation together with the patient and other health care professionals could offer added value. Ideally the START-STOPP criteria can be used as guidance for medication management, leaving room for individual differences based on the profile of the individual patient.

REFERENCES(1) Gallager P., Ryan C., Byrne S., et al. STOPP (Screening Tool of Older Persons’

Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment): consensus valitation. Int J Clin Pharm Ther 2008; 46: 72-83