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Randomized Controlled Trial
, 64 (8), 1558-66

Prevention of Hospital-Acquired Adverse Drug Reactions in Older People Using Screening Tool of Older Persons' Prescriptions and Screening Tool to Alert to Right Treatment Criteria: A Cluster Randomized Controlled Trial

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Randomized Controlled Trial

Prevention of Hospital-Acquired Adverse Drug Reactions in Older People Using Screening Tool of Older Persons' Prescriptions and Screening Tool to Alert to Right Treatment Criteria: A Cluster Randomized Controlled Trial

Marie N O'Connor et al. J Am Geriatr Soc.

Abstract

Objectives: To determine whether use of the Screening Tool of Older Persons' Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) criteria reduces incident hospital-acquired adverse drug reactions (ADRs), 28-day medication costs, and median length of hospital stay in older adults admitted with acute illness.

Design: Single-blind cluster randomized controlled trial (RCT) of unselected older adults hospitalized over a 13-month period.

Setting: Tertiary referral hospital in southern Ireland.

Participants: Consecutively admitted individuals aged 65 and older (N = 732).

Intervention: Single time point presentation to attending physicians of potentially inappropriate medications according to the STOPP/START criteria.

Measurements: The primary outcome was the proportion of participants experiencing one or more ADRs during the index hospitalization. Secondary outcomes were median length of stay (LOS) and 28-day total medication cost.

Results: One or more ADRs occurred in 78 of the 372 control participants (21.0%; median age 78, interquartile range (IQR) 72-84) and in 42 of the 360 intervention participants (11.7%; median age 80, IQR 73-85) (absolute risk reduction = 9.3%, number needed to treat = 11). The median LOS in the hospital was 8 days (IQR 4-14 days) in both groups. At discharge, median medication cost was significantly lower in the intervention group (€73.16, IQR €38.68-121.72) than in the control group (€90.62, IQR €49.38-162.53) (Wilcoxon rank test Z statistic = -3.274, P < .001).

Conclusion: Application of STOPP/START criteria resulted in significant reductions in ADR incidence and medication costs in acutely ill older adults but did not affect median LOS.

Keywords: STOPP/START criteria; adverse drug reaction; elderly; prevention.

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