Prescriber implementation of STOPP/START recommendations for hospitalised older adults: a comparison of a pharmacist approach and a physician approach

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dc.contributor.author Dalton, Kieran
dc.contributor.author O'Mahony, Denis
dc.contributor.author O'Sullivan, David
dc.contributor.author O'Connor, Marie N.
dc.contributor.author Byrne, Stephen
dc.date.accessioned 2019-02-11T09:55:28Z
dc.date.available 2019-02-11T09:55:28Z
dc.date.issued 2019-01-19
dc.identifier.citation Dalton, K., O'Mahony, D., O'Sullivan, D., O'Connor, M. N. and Byrne, S.(2019) 'Prescriber implementation of STOPP/START recommendations for hospitalised older adults: a comparison of a pharmacist approach and a physician approach', Drugs and Aging, pp. 1-10. doi:10.1007/s40266-018-0627-2 en
dc.identifier.startpage 1 en
dc.identifier.endpage 10 en
dc.identifier.issn 1179-1969
dc.identifier.issn 1170-229X
dc.identifier.uri http://hdl.handle.net/10468/7472
dc.identifier.doi 10.1007/s40266-018-0627-2
dc.description.abstract Background: Two randomised controlled trials (RCTs) conducted simultaneously in the same Irish university teaching hospital have shown that provision of Screening Tool of Older Persons’ Prescriptions (STOPP)/Screening Tool to Alert doctors to Right Treatment (START) recommendations to attending prescribers by a physician or a pharmacist can reduce in-hospital adverse drug reactions (ADRs) in older adults (≥ 65 years). The aims of this study were to compare the prescriber implementation rates of STOPP/START recommendations between the physician approach and the pharmacist approach in these two RCTs and to provide a narrative summary of the comparable clinical outcomes. Methods: Data were extracted from the two RCT published papers and their associated computerised databases to calculate the percentage prescriber implementation rates for the STOPP/START recommendations. The Chi-square test was used to quantify the differences in prescriber implementation rates, with differences considered statistically significant where p < 0.05. Results: Prescriber implementation rates of the STOPP and START recommendations made by the physician were 81.2% and 87.4% respectively, significantly higher than those made by the pharmacist (39.2% and 29.5% respectively), p < 0.0001. A greater absolute risk reduction in patients with ADRs was shown with the physician’s intervention compared to the pharmacist’s intervention (9.3% vs 6.8%). Conclusion: This study shows that the methods of communication and the medium through which the STOPP/START recommendations are delivered significantly affect their implementation. Non-implementation of some pharmacist-delivered recommendations may be contributing to preventable ADRs in older adults. Thus, future research should aim to identify the factors influencing prescriber implementation of pharmacist recommendations in order to inform the design of more effective pharmacist interventions in optimising older patients’ pharmacotherapy. en
dc.description.sponsorship Health Research Board (Grant HRA_HSR/2010/14) en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher Springer Nature Switzerland AG en
dc.rights © 2019, Springer Nature Switzerland AG. This is a post-peer-review, pre-copyedit version of an article published in Drugs and Aging. The final authenticated version is available online at: https://dx.doi.org/10.1007/s40266-018-0627-2 en
dc.subject Cost-effectiveness en
dc.subject Pharmacotherapy optimisation en
dc.subject Multi-morbid older adults en
dc.title Prescriber implementation of STOPP/START recommendations for hospitalised older adults: a comparison of a pharmacist approach and a physician approach en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Kieran Dalton, School Of Pharmacy, University College Cork, Cork, Ireland. +353-21-490-3000 Email: kieran.dalton@ucc.ie en
dc.internal.availability Full text available en
dc.check.info Access to this article is restricted until 12 months after publication by request of the publisher. en
dc.check.date 2020-01-19
dc.date.updated 2019-02-11T09:39:56Z
dc.description.version Accepted Version en
dc.internal.rssid 473190595
dc.contributor.funder Seventh Framework Programme en
dc.contributor.funder Health Research Board en
dc.description.status Peer reviewed en
dc.identifier.journaltitle Drugs and Aging en
dc.internal.copyrightchecked Yes en
dc.internal.licenseacceptance Yes en
dc.internal.IRISemailaddress kieran.dalton@ucc.ie en
dc.internal.IRISemailaddress denis.omahony@ucc.ie en
dc.internal.bibliocheck In press. Check vol / issue / page range. Amend citation as necessary.
dc.relation.project info:eu-repo/grantAgreement/EC/FP7::SP1::HEALTH/305930/EU/Development and clinical trials of a new Software ENgine for the Assessment & Optimization of drug and non-drug Therapy in Older peRsons/SENATOR en


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