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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Bibliographic Details
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
Wiley Subscription Services, Inc
Subjects:
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
Online Access:Get full text
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Summary: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.
Bibliography: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
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ISSN:0002-8614
1532-5415
DOI:10.1111/jgs.14312