Prevention of adverse drug events in hospitalized older patients: A randomised controlled trial using STOPP/START criteria

  • O'Connor M
  • O'Sullivan D
  • Gallagher P
 et al. 
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Abstract

Text.- Introduction.- Adverse drug reactions (ADRs) are a major cause of morbidity and healthcare utilisation in older people. Inappropriate prescribing (IP) is an established risk factor for ADRs and can be modified by physician intervention. However, to date, significant reductions in ADR incidence following clinical application of IP screening criteria have not been demonstrated. We aimed to test the hypothesis that screening of older patients prescriptions with STOPP/START criteria at the point of hospitalisation would reduce the incidence of in-hospital ADRs (Registered trial number NCT 01467050). Methods.- We randomised 720 patients aged>65 years to receive either the usual pharmaceutical care (control) or screening with STOPP/START criteria on admission followed up with written recommendations to their attending physician (intervention). ADRs were identified by patient and physician consultation together with case-note analysis during admission and prior to discharge. Causality was defined using WHO-UMC criteria. Results.- Demographics, co-morbidities and medication use were similar in both groups on admission [median (IQR) age 79 (73-85) years (intervention group) and 78 (72-84) years (control group); median (IQR) number of medications 9 (6-11) intervention and 8 (5-11) control group]. Significantly fewer ADRs occurred in the STOPP/START intervention group (n = 38; 21 certain/probable) compared to control group (n = 60; 29 certain/probable) (relative risk reduction 36.6%, number needed to screen with STOPP/START IP criteria to prevent one in-hospital ADR was 16). Conclusion.- Prospective screening of older persons' prescriptions on admission to hospital with the IP tool STOPP/START can significantly reduce ADR incidence.

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Authors

  • M O'Connor

  • D O'Sullivan

  • P Gallagher

  • S Byrne

  • J Eustace

  • D O'Mahony

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