Résumé
Objectif
STOPP-START est un outil de détection de la prescription médicamenteuse inappropriée chez la personne âgée. Récemment validé en anglais, c’est un outil fiable, facile d’utilisation, permettant d’évaluer des prescriptions souvent décrites comme inappropriées et/ou sub-optimales dans cette population. Nous présentons son adaptation en français.
Méthode
Une méthode de traduction-traduction inverse avec validation de la version obtenue par des experts francophones belges, canadiens, français et suisses a été utilisée. Une analyse de concordance inter-juges a complété la validation. Cinquante dossiers de patients (âge moyen ± écart type: 77,6 ± 7,9 ans, 70% étaient des femmes) hospitalisés dans un département académique de gériatrie ont été analysés indépendamment par un gériatre et un médecin généraliste.
Résultats
L’adaptation reprend les 87 critères STOPP-START de la version originale, présentés selon les systèmes physiologiques. Les 50 dossiers concernaient 418 prescriptions (médiane 8; écart interquartile 5–12). Les proportions d’accord positif et négatif inter-observateurs étaient respectivement de 99% et 95% pour STOPP et 99% et 88% pour START; les coefficients ? étaient de 0,95 pour STOPP et 0,92 pour START. Ces résultats indiquaient une excellente concordance inter-juges.
Conclusion
Cette adaptation francophone apparaît ainsi aussi attractive, logique et fiable que l’outil original. Ses performances dans la prévention d’effets indésirables associés à la prescription inappropriée devront encore être démontrées par un essai contrôlé.
Mots clés: STOPP-START, prescription inappropriée, omission de prescription, effets indésirables médicamenteux, outil de dépistage, sujets ages
Abstract
Objective
STOPP-START is a screening tool for detecting inappropriate prescriptions in older people. Recently validated in its English-language version, it is a reliable and easy-to-use tool, allowing assessment of prescription drugs often described as inappropriate (STOPP) or unnecessarily underused (START) in this population. An adaptation of the tool into French language is presented here.
Method
A translation-back translation method, with validation of the obtained version by French-speaking experts from Belgium, Canada, France and Switzerland, has been used. An inter-rater reliability analysis completed the validation process. Fifty data sets of patients hospitalized in an academic geriatrics department (mean age ± standard deviation: 77.6 ± 7.9 years; 70% were women) were analyzed independently by one geriatrician and one general practitioner.
Results
The adaptation in French considers the 87 STOPP-START criteria of the original version. They are all organized according to physiological systems. The 50 data sets involved 418 prescribed medications (median 8; inter-quartile range 5–12). The proportions of positive and negative inter-observer agreements were 99% and 95% respectively for STOPP, and 99% and 88% for START; Cohen’s к-coefficients were 0.95 for STOPP and 0.92 for START. These results indicated an excellent inter-rater agreement.
Conclusion
Therefore, this French language version of STOPP-START is as reliable as the original English language version of the tool. For STOPPSTART to have tangible clinical benefit to patients, a randomized controlled trial must be undertaken to demonstrate efficacy in the prevention of adverse clinical events connected with inappropriate prescriptions.
Key words: STOPP START, inappropriate prescription, omission of prescription, adverse drugs event, screening tool, elderly
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