Computer-generated STOPP/START recommendations for hospitalised older adults: evaluation of the relationship between clinical relevance and rate of implementation in the SENATOR trial

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dc.check.date2021-06-02
dc.check.infoAccess to this article is restricted until 12 months after publication by request of the publisher.en
dc.contributor.authorDalton, Kieran
dc.contributor.authorCurtin, Denis
dc.contributor.authorO'Mahony, Denis
dc.contributor.authorByrne, Stephen
dc.contributor.funderSeventh Framework Programmeen
dc.date.accessioned2020-08-12T09:27:12Z
dc.date.available2020-08-12T09:27:12Z
dc.date.issued2020-06-02
dc.date.updated2020-08-12T09:17:07Z
dc.description.abstractBackground: findings from a recent qualitative study indicate that the perceived clinical relevance of computer-generated STOPP/START recommendations was a key factor affecting their implementation by physician prescribers caring for hospitalised older adults in the SENATOR trial. Aim: to systematically evaluate the clinical relevance of these recommendations and to establish if clinical relevance significantly affected the implementation rate. Methods: a pharmacist–physician pair retrospectively reviewed the case records for all SENATOR trial intervention patients at Cork University Hospital and assigned a degree of clinical relevance for each STOPP/START recommendation based on a previously validated six-point scale. The chi-square test was used to quantify the differences in prescriber implementation rates between recommendations of varying clinical relevance, with statistical significance set at P < 0.05. Results: in 204 intervention patients, the SENATOR software produced 925 STOPP/START recommendations. Nearly three quarters of recommendations were judged to be clinically relevant (73.6%); however, nearly half of these were deemed of ‘possibly low relevance’ (320/681; 47%). Recommendations deemed of higher clinical relevance were significantly more likely to be implemented than those of lower clinical relevance (P < 0.05). Conclusions: a large proportion (61%) of the computer-generated STOPP/START recommendations provided were of potential ‘adverse significance’, of ‘no clinical relevance’ or of ‘possibly low relevance’. The adjudicated clinical relevance of computer-generated medication recommendations significantly affects their implementation. Meticulous software refinement is required for future interventions of this type to increase the proportion of recommendations that are of high clinical relevance. This should facilitate their implementation, resulting in prescribing optimisation and improved clinical outcomes for multimorbid older adults.en
dc.description.statusPeer revieweden
dc.description.versionAccepted Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationDalton, K., Curtin, D., O'Mahony, D. and Byrne, S. (2020) 'Computer-generated STOPP/START recommendations for hospitalised older adults: evaluation of the relationship between clinical relevance and rate of implementation in the SENATOR trial', Age and Ageing, 49(4), pp. 615-621. doi: 10.1093/ageing/afaa062en
dc.identifier.doi10.1093/ageing/afaa062en
dc.identifier.eissn1468-2834
dc.identifier.endpage621en
dc.identifier.issn0002-0729
dc.identifier.issued4en
dc.identifier.journaltitleAge and Ageingen
dc.identifier.startpage615en
dc.identifier.urihttps://hdl.handle.net/10468/10382
dc.identifier.volume49en
dc.language.isoenen
dc.publisherOxford University Pressen
dc.relation.projectinfo: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/SENATORen
dc.rights© 2020, the Authors. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. This is a pre-copyedited, author-produced version of an article accepted for publication in Age and Ageing following peer review. The version of record is available online at: https://doi.org/10.1093/ageing/afaa062en
dc.subjectPrescribingen
dc.subjectAgeden
dc.subjectHospitalen
dc.subjectSTOPP/STARTen
dc.subjectPharmacotherapyen
dc.subjectOlder peopleen
dc.titleComputer-generated STOPP/START recommendations for hospitalised older adults: evaluation of the relationship between clinical relevance and rate of implementation in the SENATOR trialen
dc.typeArticle (peer-reviewed)en
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