Table 3.
Ten most common identified screening tool of older person’s prescriptions and screening tool to alert to the right treatment (STOPP/START) criteria of 2331 recommendations made, and implementation at two months
| STOPP/START | Description | No (%) | ||
|---|---|---|---|---|
| Count in intervention group | Implemented* | Not implemented | ||
| STOPP | ||||
| STOPP A1† | Any drug prescribed without an evidence based clinical indication | 828 (35.5) | 428 (51.7) | 400 (48.3) |
| STOPP A3 | Any duplicate drug class prescription | 147 (6.3) | 95 (64.6) | 52 (35.4) |
| STOPP D5 | Benzodiazepines for ≥4 weeks | 115 (4.9) | 45 (39.1) | 70 (60.9) |
| START | ||||
| START E3 | Vitamin D supplement in patients with known osteoporosis and with previous fragility fracture or BMD T scores >−2.0 in multiple sites, or both | 96 (4.1) | 22 (22.9) | 74 (77.1) |
| START H2 | Laxatives in patients receiving opioids regularly | 82 (3.5) | 12 (14.6) | 70 (85.4) |
| START A6 | Angiotensin converting enzyme inhibitor with systolic heart failure or documented coronary artery disease, or both | 80 (3.4) | 19 (23.8) | 61 (76.3) |
| START E5 | Vitamin D supplement in older people who are housebound, experiencing falls, or with osteopenia (BMD T score >−1.0 but <−2.5 in multiple sites) | 80 (3.4) | 31 (38.8) | 49 (61.3) |
| START E2 | Bisphosphonates and vitamin D and calcium in patients taking long term systemic corticosteroid | 74 (3.2) | 21 (28.4) | 53 (71.6) |
| START E4 | Bone antiresorptive or anabolic treatment‡ in patients with documented osteoporosis, where no drug or clinical status contraindication exists (BMD T scores <−2.5 in multiple sites) or history of fragility fracture, or both | 71 (3.0) | 9 (12.7) | 62 (87.3) |
| START A5 | Statin treatment with a documented history of coronary, cerebral, or peripheral vascular disease, unless the patient’s status is end of life or age is >85 years | 62 (2.7) | 14 (22.6) | 48 (77.4) |
BMD=bone mineral density.
START I1 and I2 criteria and some STRIPA (systematic tool to reduce inappropriate prescribing facilitated by web based STRIP assistant) generated signals that could not be interpreted as implemented recommendations were omitted from analysis.
10 most common identified drug classes with no evidence based indication, in descending order of frequency: antacids, mineral supplements, psychoanaleptics, lipid modifying agents, psychotropics, antithrombotics, vitamin, analgesics (including opioids), laxatives, and drugs for obstructive airway diseases.
For example, bisphosphonate, strontium ranelate, teriparatide, denosumab.