Prevention of Hospital-Acquired Adverse Drug Reactions in Older People Using Screening Tool of Older Persons' Prescriptions and Screening Tool to Alert to Right Treatment Criteria: A Cluster Randomized Controlled Trial

Objectives To determine whether use of the Screening Tool of Older Persons' Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) criteria reduces incident hospital‐acquired adverse drug reactions (ADRs), 28‐day medication costs, and median length of hospital stay in olde...

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Vydáno v:	Journal of the American Geriatrics Society (JAGS) Ročník 64; číslo 8; s. 1558 - 1566
Hlavní autoři:	O'Connor, Marie N., O'Sullivan, David, Gallagher, Paul F., Eustace, Joseph, Byrne, Stephen, O'Mahony, Denis
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States Blackwell Publishing Ltd 01.08.2016 Wiley Subscription Services, Inc
Témata:	Adults adverse drug reaction Adverse Drug Reaction Reporting Systems - economics Adverse Drug Reaction Reporting Systems - statistics & numerical data Aged Aged, 80 and over Clinical trials Cluster Analysis Costs Criteria Critical incidents Drug abuse Drug Costs - statistics & numerical data Drug prices Drug-Related Side Effects and Adverse Reactions - economics Drug-Related Side Effects and Adverse Reactions - epidemiology Drug-Related Side Effects and Adverse Reactions - prevention & control Drugs elderly Female Geriatrics Hospitalization Hospitalization - economics Hospitalization - statistics & numerical data Hospitals Humans Inappropriate Prescribing - economics Inappropriate Prescribing - prevention & control Inappropriate Prescribing - statistics & numerical data Inappropriateness Intervention Ireland Length of stay Length of Stay - economics Length of Stay - statistics & numerical data Male Mass Screening - economics Mass Screening - statistics & numerical data Medical referrals Medical screening Medical treatment Medication Systems, Hospital - economics Medication Systems, Hospital - statistics & numerical data Number needed to treat Older people Pharmacology Physicians Prescription drugs prevention Risk reduction Side effects Single-Blind Method STOPP/START criteria Tests STOPP/START criteria adverse drug reaction elderly prevention
ISSN:	0002-8614, 1532-5415
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Shrnutí:	Objectives To determine whether use of the Screening Tool of Older Persons' Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) criteria reduces incident hospital‐acquired adverse drug reactions (ADRs), 28‐day medication costs, and median length of hospital stay in older adults admitted with acute illness. Design Single‐blind cluster randomized controlled trial (RCT) of unselected older adults hospitalized over a 13‐month period. Setting Tertiary referral hospital in southern Ireland. Participants Consecutively admitted individuals aged 65 and older (N = 732). Intervention Single time point presentation to attending physicians of potentially inappropriate medications according to the STOPP/START criteria. Measurements The primary outcome was the proportion of participants experiencing one or more ADRs during the index hospitalization. Secondary outcomes were median length of stay (LOS) and 28‐day total medication cost. Results One or more ADRs occurred in 78 of the 372 control participants (21.0%; median age 78, interquartile range (IQR) 72–84) and in 42 of the 360 intervention participants (11.7%; median age 80, IQR 73–85) (absolute risk reduction = 9.3%, number needed to treat = 11). The median LOS in the hospital was 8 days (IQR 4–14 days) in both groups. At discharge, median medication cost was significantly lower in the intervention group (€73.16, IQR €38.68–121.72) than in the control group (€90.62, IQR €49.38–162.53) (Wilcoxon rank test Z statistic = −3.274, P < .001). Conclusion Application of STOPP/START criteria resulted in significant reductions in ADR incidence and medication costs in acutely ill older adults but did not affect median LOS.
Bibliografie:	ark:/67375/WNG-8D5HRF14-F Table S1. Diagnostic profiles of the control and intervention groups. Table S2. Frequency of potentially inappropriate prescriptions in the intervention group. Health Research Board of Ireland - No. HRA_HSR/2010/14 ArticleID:JGS14312 istex:6093B8E7CE0B47269B444E34C6368DCFFBE606B0 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 ObjectType-Undefined-3
ISSN:	0002-8614 1532-5415
DOI:	10.1111/jgs.14312