Abstract
Frequency and acceptance of clinical decision support system generated STOPP/START signals for
hospitalised older patients with polypharmacy and
multimorbidity
Background
The Screening Tool of Older Persons’ Prescriptions
(STOPP)/Screening Tool to Alert doctors to Right
Treatment (START) instrument is a screening tool
to evaluate the medication regimen in older people. STOPP/START criteria have been converted
into software algorithms and implemented in a
clinical decision support system (CDSS) to facilitate
their use in clinical practice.
Objective
To determine the acceptance of CDSS generated
STOPP/START signals by a pharmacotherapy team
in hospitalised older patients with polypharmacy
and multimorbidity.
Design and methods
Hospitalised multimorbid older patients with polypharmacy assigned to the Dutch intervention arm
of the OPERAM (OPtimising thERapy to prevent
Avoidable hospital admissions in the Multimorbid
elderly) trial were included. Intervention patients
received a CDSS-assisted structured medication
review. The acceptance of CDSS-generated
STOPP/START signals by a pharmacotherapy team
and determinants for acceptance were evaluated.
Results
In 98% of the 203 included patients, at least one
STOPP/START signal was generated. Overall,
43.1% of all 1059 signals were accepted. STOPP
signals (51.5%) were more likely than START signals (39.1%) to be accepted per patient (mean difference: 12.4%; 95% confidence
interval 4.7-20.1). A history of falls was positively
associated with acceptance (+11.8%) while prior
hospitalization (−10.7%), decreased renal function
(−11.2%) and long hospital stay (−9.0%) were negatively associated with acceptance.
Conclusion
About half of the generated STOPP/START signals
were accepted by the pharmacotherapy team. The
nature of the signal was a better predictor for
acceptance than patient or setting related factors
hospitalised older patients with polypharmacy and
multimorbidity
Background
The Screening Tool of Older Persons’ Prescriptions
(STOPP)/Screening Tool to Alert doctors to Right
Treatment (START) instrument is a screening tool
to evaluate the medication regimen in older people. STOPP/START criteria have been converted
into software algorithms and implemented in a
clinical decision support system (CDSS) to facilitate
their use in clinical practice.
Objective
To determine the acceptance of CDSS generated
STOPP/START signals by a pharmacotherapy team
in hospitalised older patients with polypharmacy
and multimorbidity.
Design and methods
Hospitalised multimorbid older patients with polypharmacy assigned to the Dutch intervention arm
of the OPERAM (OPtimising thERapy to prevent
Avoidable hospital admissions in the Multimorbid
elderly) trial were included. Intervention patients
received a CDSS-assisted structured medication
review. The acceptance of CDSS-generated
STOPP/START signals by a pharmacotherapy team
and determinants for acceptance were evaluated.
Results
In 98% of the 203 included patients, at least one
STOPP/START signal was generated. Overall,
43.1% of all 1059 signals were accepted. STOPP
signals (51.5%) were more likely than START signals (39.1%) to be accepted per patient (mean difference: 12.4%; 95% confidence
interval 4.7-20.1). A history of falls was positively
associated with acceptance (+11.8%) while prior
hospitalization (−10.7%), decreased renal function
(−11.2%) and long hospital stay (−9.0%) were negatively associated with acceptance.
Conclusion
About half of the generated STOPP/START signals
were accepted by the pharmacotherapy team. The
nature of the signal was a better predictor for
acceptance than patient or setting related factors
| Original language | Dutch |
|---|---|
| Article number | a1767 |
| Number of pages | 8 |
| Journal | Nederlands Platform voor Farmaceutisch Onderzoek |
| Volume | 2023 |
| Issue number | 8 |
| Publication status | Published - 2023 |