Adverse Drug Reaction Clinical Trial
Official title:
Prevention of Adverse Drug Events (ADEs) in Hospitalised Older Patients Using STOPP/START Criteria
The next four decades will see a marked expansion of the elderly population in Ireland, in
particular people aged over 80 yrs. Persons aged over 80 are the highest consumers of
prescription medicines in Ireland and have the highest prevalence rates of major
polypharmacy. Polypharmacy is intimately linked with serious adverse drug events (ADEs) and
consequent major morbidity and mortality. Epidemiological data from the United States
indicate that ADEs is the fifth most common cause of death nationally. Experts suggest that
effective evidence based interventions can be applied to this major public health problem.
Recent research data indicate a cause-and-effect relationship between inappropriate
prescription medicines and serious ADEs in older people in hospital. To date, Beers' criteria
have been the dominant set of criteria for defining potentially inappropriate medicines
(PIMs) in late life. Research data collected by this group show that the recently validated
STOPP/START criteria (Screening Tool of Older Persons' Prescriptions and Screening Tool to
Alert doctors to Right Treatment) identify ADEs that are causal or contributory to acute
hospital admission in older people 2.7 times more frequently than Beers' criteria. Based on
these findings, our hypothesis is that STOPP/START criteria have the potential to be used as
a regular intervention for the purpose of ADE prevention in older people. A recent single
centre randomised control trial (RCT) undertaken at Cork University Hospital showed that
prospective application of STOPP/START criteria led to a highly significant improvement in
medication appropriateness in older hospitalised patients compared with standard inpatient
pharmaceutical care. Significantly, the improvement in medication appropriateness was
maintained to the end of the study follow-up i.e. 6 months post-discharge. However, the
ability of STOPP/START criteria to significantly reduce ADEs in a prospective RCT has yet to
be demonstrated.
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