Adverse Drug Reaction Clinical Trial
Official title:
Prevention of Adverse Drug Events (ADEs) in Hospitalised Older Patients Using STOPP/START Criteria
Verified date | June 2012 |
Source | University College Cork |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
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.
Status | Completed |
Enrollment | 732 |
Est. completion date | June 2012 |
Est. primary completion date | June 2012 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 65 Years and older |
Eligibility |
Inclusion Criteria: All patients aged 65 years and over presenting to CUH Accident and Emergency Departments with acute illness for admission under a medical or surgical team. Exclusion Criteria: 1. Age less than 65 years. 2. Patient to be admitted under the care of a Geriatrician Psychiatrist of Old Age or Clinical Pharmacologist, or having been admitted under these services or attended their outpatient clinics in the previous 12 months. (These doctor groups are likely to minimise inappropriate medications in this population). 3. Terminally ill patient attended by palliative care team. 4. Critically ill patient e.g. admitted to Intensive Care Unit. 5. Patients who do not wish to participate in the study. 6. Patients whose hospital physician does not wish to participate in the study. |
Country | Name | City | State |
---|---|---|---|
Ireland | Cork University Hospital | Cork | Munster |
Lead Sponsor | Collaborator |
---|---|
University College Cork |
Ireland,
Gallagher P, Ryan C, Byrne S, Kennedy J, O'Mahony D. STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008 Feb;46(2):72-83. — View Citation
Gallagher PF, O'Connor MN, O'Mahony D. Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria. Clin Pharmacol Ther. 2011 Jun;89(6):845-54. doi: 10.1038/clpt.2011.44. Epub 2011 Apr 20. — View Citation
Hamilton H, Gallagher P, Ryan C, Byrne S, O'Mahony D. Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients. Arch Intern Med. 2011 Jun 13;171(11):1013-9. doi: 10.1001/archinternmed.2011.215. — View Citation
O'Mahony D, Gallagher PF. Inappropriate prescribing in the older population: need for new criteria. Age Ageing. 2008 Mar;37(2):138-41. doi: 10.1093/ageing/afm189. Review. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Number of patients with probable and definite adverse drug events in hospital | Up to Day 14 of hospital admission | ||
Secondary | drug ingredient cost at hospital discharge | Up to day 14 | ||
Secondary | Composite health resource utilization including hospital readmissions and primary care consultations | At 3 months post discharge from hospital |
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