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.check.date2020-01-19
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.authorO'Mahony, Denis
dc.contributor.authorO'Sullivan, David.
dc.contributor.authorO'Connor, Marie N.
dc.contributor.authorByrne, Stephen
dc.contributor.funderSeventh Framework Programmeen
dc.contributor.funderHealth Research Boarden
dc.date.accessioned2019-02-11T09:55:28Z
dc.date.available2019-02-11T09:55:28Z
dc.date.issued2019-01-19
dc.date.updated2019-02-11T09:39:56Z
dc.description.abstractBackground: 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.sponsorshipHealth Research Board (Grant HRA_HSR/2010/14)en
dc.description.statusPeer revieweden
dc.description.versionAccepted Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationDalton, 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/s40266-018-0627-2en
dc.identifier.doi10.1007/s40266-018-0627-2
dc.identifier.endpage10en
dc.identifier.issn1179-1969
dc.identifier.issn1170-229X
dc.identifier.journaltitleDrugs and Agingen
dc.identifier.startpage1en
dc.identifier.urihttps://hdl.handle.net/10468/7472
dc.language.isoenen
dc.publisherSpringer Nature Switzerland AGen
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© 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/s40266-018-0627-2en
dc.subjectCost-effectivenessen
dc.subjectPharmacotherapy optimisationen
dc.subjectMulti-morbid older adultsen
dc.titlePrescriber implementation of STOPP/START recommendations for hospitalised older adults: a comparison of a pharmacist approach and a physician approachen
dc.typeArticle (peer-reviewed)en
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