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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Published in:Journal of the American Geriatrics Society (JAGS) Vol. 64; no. 8; pp. 1558 - 1566
Main Authors: O'Connor, Marie N., O'Sullivan, David, Gallagher, Paul F., Eustace, Joseph, Byrne, Stephen, O'Mahony, Denis
Format: Journal Article
Language:English
Published: United States Blackwell Publishing Ltd 01.08.2016
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ISSN:0002-8614, 1532-5415
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Abstract 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.
AbstractList 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.
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. Single-blind cluster randomized controlled trial (RCT) of unselected older adults hospitalized over a 13-month period. Tertiary referral hospital in southern Ireland. Consecutively admitted individuals aged 65 and older (N = 732). Single time point presentation to attending physicians of potentially inappropriate medications according to the STOPP/START criteria. 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. 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). 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.
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 ([euro]73.16, IQR [euro]38.68-121.72) than in the control group ([euro]90.62, IQR [euro]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.
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 ([Euro73.16, IQR [Euro38.68-121.72) than in the control group ([Euro90.62, IQR [Euro49.38-162.53) (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.
OBJECTIVESTo 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.DESIGNSingle-blind cluster randomized controlled trial (RCT) of unselected older adults hospitalized over a 13-month period.SETTINGTertiary referral hospital in southern Ireland.PARTICIPANTSConsecutively admitted individuals aged 65 and older (N = 732).INTERVENTIONSingle time point presentation to attending physicians of potentially inappropriate medications according to the STOPP/START criteria.MEASUREMENTSThe 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.RESULTSOne 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).CONCLUSIONApplication 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.
Author Eustace, Joseph
O'Connor, Marie N.
O'Sullivan, David
Gallagher, Paul F.
O'Mahony, Denis
Byrne, Stephen
Author_xml – sequence: 1
  givenname: Marie N.
  surname: O'Connor
  fullname: O'Connor, Marie N.
  organization: Division of Geriatrics, Department of Medicine, University College Cork, Cork, Ireland
– sequence: 2
  givenname: David
  surname: O'Sullivan
  fullname: O'Sullivan, David
  organization: School of Pharmacy, University College Cork, Cork, Ireland
– sequence: 3
  givenname: Paul F.
  surname: Gallagher
  fullname: Gallagher, Paul F.
  organization: Division of Geriatrics, Department of Medicine, University College Cork, Cork, Ireland
– sequence: 4
  givenname: Joseph
  surname: Eustace
  fullname: Eustace, Joseph
  organization: Health Research Board Clinical Research Facility, University College Cork, Cork, Ireland
– sequence: 5
  givenname: Stephen
  surname: Byrne
  fullname: Byrne, Stephen
  organization: School of Pharmacy, University College Cork, Cork, Ireland
– sequence: 6
  givenname: Denis
  surname: O'Mahony
  fullname: O'Mahony, Denis
  email: denis.omahony@ucc.ie
  organization: Division of Geriatrics, Department of Medicine, University College Cork, Cork, Ireland
BackLink https://www.ncbi.nlm.nih.gov/pubmed/27365262$$D View this record in MEDLINE/PubMed
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ContentType Journal Article
Copyright 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society
2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.
2016 American Geriatrics Society and Wiley Periodicals, Inc.
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Issue 8
Keywords STOPP/START criteria
adverse drug reaction
elderly
prevention
Language English
License http://onlinelibrary.wiley.com/termsAndConditions#vor
2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.
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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
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References Hanlon JT, Pieper CF, Hajjar ER et al. Incidence and predictors of all and preventable adverse drug reactions in frail elderly persons after hospital stay. J Gerontol A Biol Sci Med Sci 2006;61A:511-555.
Onder G, van der Cammen TJ, Petrovic M et al. Strategies to reduce the risk of iatrogenic illness in complex older adults. Age Ageing 2013;42:284-291.
By the American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc 2015;63:2227-2246.
Scott I, Jayathissa S. Quality of drug prescribing in older patients: Is there a problem and can we improve it? Intern Med J 2010;40:7-18.
O'Connor MN, Gallagher P, Byrne S et al. Adverse drug reactions in older patients during hospitalisation: Are they predictable? Age Ageing 2012;41:771-776.
Nguyen JK, Fouts MM, Kotabe SE et al. Polypharmacy as a risk factor for adverse drug reactions in geriatric nursing home residents. Am J Geriatr Pharmacother 2006;4:36-41.
O'Sullivan DP, O'Mahony D, Parsons C et al. A prevalence study of potentially inappropriate prescribing in Irish long-term care residents. Drugs Aging 2013;30:39-49.
Patel TK, Patel PB. Incidence of adverse drug reactions in Indian hospitals: A systematic review of prospective studies. Curr Drug Saf 2016;11:128-136.
Hamilton H, Gallagher P, Ryan C et al. Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients. Arch Intern Med 2011;171:1013-1019.
Frankenthal D, Lerman Y, Kalendaryev E et al. Intervention with the Screening Tool of Older Persons Potentially Inappropriate Prescriptions/Screening Tool to Alert Doctors to Right Treatment criteria in elderly residents of a chronic geriatric facility: A randomized clinical trial. J Am Geriatr Soc 2014;62:1658-1665.
Leendertse AJ, Van Den Bemt PM, Poolman JB et al. Preventable hospital admissions related to medication (HARM): Cost analysis of the HARM study. Value Health 2011;14:34-40.
Dalleur O, Boland B, Losseau C et al. Reduction of potentially inappropriate medications using the STOPP criteria in frail older inpatients: A randomised controlled study. Drugs Aging 2014;31:291-298.
Hallas J, Harvald B, Gram LF et al. Drug related hospital admissions: The role of definitions and intensity of data collection, and the possibility of prevention. J Intern Med 1990;228:83-90.
Gillespie U, Alassaad A, Henrohn D et al. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: A randomized controlled trial. Arch Intern Med 2009;169:894-900.
Gallagher P, Ryan C, Byrne S et al. STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther 2008;46:72-83.
Hofer-Dueckelmann C, Prinz E, Beindl W et al. Adverse drug reactions (ADRs) associated with hospital admissions-elderly female patients are at highest risk. Int J Clin Pharmacol Ther 2011;49:577-586.
Gallagher P, O'Connor MN, O'Mahony D. Prevention of potentially inappropriate prescribing for elderly patients: A randomized controlled trial using STOPP/START criteria. Clin Pharmacol Ther 2011;89:845-854.
Gallagher P, Lang PO, Cherubini A et al. Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals. Eur J Clin Pharmacol 2011;67:1175-1188.
Bierman AS, Pugh MJ, Dhalla I et al. Sex differences in inappropriate prescribing among elderly veterans. Am J Geriatr Pharmacother 2007;5:147-161.
O'Mahony D, O'Sullivan D, Byrne S et al. STOPP/START criteria for potentially inappropriate prescribing in older people: Version 2. Age Ageing 2014;44:213-218.
Ryan C, O'Mahony D, Kennedy J et al. Potentially inappropriate prescribing in older residents in Irish nursing homes. Age Ageing 2013;42:116-120.
Hajjar ER, Hanlon JT, Artz MB et al. Adverse drug reaction risk factors in older outpatients. Am J Geriatr Pharmacother 2003;1:82-89.
Ryan C, O'Mahony D, Kennedy J et al. Potentially inappropriate prescribing in an Irish elderly population in primary care. Br J Clin Pharmacol 2009;68:936-947.
Lindley CM, Tully MP, Paramsothy V et al. Inappropriate medication is a major cause of adverse drug reactions in elderly patients. Age Ageing 1992;21:294-300.
Petrovic M, van der Cammen T, Onder G. Adverse drug reactions in older people: Detection and prevention. Drugs Aging 2012;29:453-462.
Kongkaew C, Noyce PR, Ashcroft DM. Hospital admissions associated with adverse drug reactions: A systematic review of prospective observational studies. Ann Pharmacother 2008;42:1017-1025.
Sikdar KC, Dowden J, Alaghehbandan R et al. Adverse drug reactions in elderly hospitalized patients: A 12-year population-based retrospective cohort study. Ann Pharmacother 2012;46:960-971.
Schmader KE, Hanlon JT, Pieper CF et al. Effects of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderly. Am J Med 2004;116:394-401.
Beers MH, Ouslander JG, Rollingher I et al. Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Arch Intern Med 1991;151:1825-1832.
Buck MD, Atreja A, Brunker CP et al. Potentially inappropriate medication prescribing in outpatient practices: Prevalence and patient characteristics based on electronic health records. Am J Geriatr Pharmacother 2009;7:84-92.
Trivalle C, Cartier T, Verny C et al. Identifying and preventing adverse drug events in elderly hospitalised patients: A randomised trial of a program to reduce adverse drug effects. J Nutr Health Aging 2010;14:57-61.
Hellström LM, Bondesson A, Höglund P et al. Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits. Eur J Clin Pharmacol 2011;67:741-752.
Anathhanam S, Powis RA, Cracknell AL et al. Impact of prescribed medications on patient safety in older people. Ther Adv Drug Saf 2012;3:165-174.
Leendertse AJ, Egberts AC, Stoker LJ et al. Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch Intern Med 2008;168:1890-1896.
1990; 228
1991; 151
2009; 68
2010; 14
2006; 61A
2010
2013; 42
1972
2006; 4
2011; 14
2008; 168
2014; 62
2011; 171
2010; 40
2014; 44
2016; 11
2004; 116
2012; 3
2015; 63
2013; 30
2008; 46
2012; 29
2009; 7
2011; 89
2011; 67
2007; 5
2003; 1
2008; 42
1992; 21
2011; 49
2012; 46
2009; 169
2012; 41
2014; 31
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– reference: Hamilton H, Gallagher P, Ryan C et al. Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients. Arch Intern Med 2011;171:1013-1019.
– reference: O'Mahony D, O'Sullivan D, Byrne S et al. STOPP/START criteria for potentially inappropriate prescribing in older people: Version 2. Age Ageing 2014;44:213-218.
– reference: Hajjar ER, Hanlon JT, Artz MB et al. Adverse drug reaction risk factors in older outpatients. Am J Geriatr Pharmacother 2003;1:82-89.
– reference: O'Sullivan DP, O'Mahony D, Parsons C et al. A prevalence study of potentially inappropriate prescribing in Irish long-term care residents. Drugs Aging 2013;30:39-49.
– reference: Nguyen JK, Fouts MM, Kotabe SE et al. Polypharmacy as a risk factor for adverse drug reactions in geriatric nursing home residents. Am J Geriatr Pharmacother 2006;4:36-41.
– reference: Kongkaew C, Noyce PR, Ashcroft DM. Hospital admissions associated with adverse drug reactions: A systematic review of prospective observational studies. Ann Pharmacother 2008;42:1017-1025.
– reference: Hellström LM, Bondesson A, Höglund P et al. Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits. Eur J Clin Pharmacol 2011;67:741-752.
– reference: Hallas J, Harvald B, Gram LF et al. Drug related hospital admissions: The role of definitions and intensity of data collection, and the possibility of prevention. J Intern Med 1990;228:83-90.
– reference: Ryan C, O'Mahony D, Kennedy J et al. Potentially inappropriate prescribing in an Irish elderly population in primary care. Br J Clin Pharmacol 2009;68:936-947.
– reference: Leendertse AJ, Egberts AC, Stoker LJ et al. Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch Intern Med 2008;168:1890-1896.
– reference: Bierman AS, Pugh MJ, Dhalla I et al. Sex differences in inappropriate prescribing among elderly veterans. Am J Geriatr Pharmacother 2007;5:147-161.
– reference: Gillespie U, Alassaad A, Henrohn D et al. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: A randomized controlled trial. Arch Intern Med 2009;169:894-900.
– reference: Trivalle C, Cartier T, Verny C et al. Identifying and preventing adverse drug events in elderly hospitalised patients: A randomised trial of a program to reduce adverse drug effects. J Nutr Health Aging 2010;14:57-61.
– reference: Hanlon JT, Pieper CF, Hajjar ER et al. Incidence and predictors of all and preventable adverse drug reactions in frail elderly persons after hospital stay. J Gerontol A Biol Sci Med Sci 2006;61A:511-555.
– reference: Schmader KE, Hanlon JT, Pieper CF et al. Effects of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderly. Am J Med 2004;116:394-401.
– reference: Sikdar KC, Dowden J, Alaghehbandan R et al. Adverse drug reactions in elderly hospitalized patients: A 12-year population-based retrospective cohort study. Ann Pharmacother 2012;46:960-971.
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– reference: Patel TK, Patel PB. Incidence of adverse drug reactions in Indian hospitals: A systematic review of prospective studies. Curr Drug Saf 2016;11:128-136.
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Snippet Objectives To determine whether use of the Screening Tool of Older Persons' Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START)...
To determine whether use of the Screening Tool of Older Persons' Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) criteria reduces...
Objectives To determine whether use of the Screening Tool of Older Persons' Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START)...
OBJECTIVESTo determine whether use of the Screening Tool of Older Persons' Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START)...
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SubjectTerms 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
Title 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
URI https://api.istex.fr/ark:/67375/WNG-8D5HRF14-F/fulltext.pdf
https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fjgs.14312
https://www.ncbi.nlm.nih.gov/pubmed/27365262
https://www.proquest.com/docview/1811697142
https://www.proquest.com/docview/1812439317
https://www.proquest.com/docview/1815700986
Volume 64
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