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

J Am Geriatr Soc. 2016 Aug;64(8):1558-66. doi: 10.1111/jgs.14312. Epub 2016 Jul 1.


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.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adverse Drug Reaction Reporting Systems / economics*
  • Adverse Drug Reaction Reporting Systems / statistics & numerical data*
  • Aged
  • Aged, 80 and over
  • Cluster Analysis
  • Drug Costs / statistics & numerical data
  • Drug-Related Side Effects and Adverse Reactions / economics*
  • Drug-Related Side Effects and Adverse Reactions / epidemiology
  • Drug-Related Side Effects and Adverse Reactions / prevention & control*
  • Female
  • Hospitalization / economics*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Inappropriate Prescribing / economics*
  • Inappropriate Prescribing / prevention & control
  • Inappropriate Prescribing / statistics & numerical data*
  • Ireland
  • Length of Stay / economics
  • Length of Stay / statistics & numerical data
  • Male
  • Mass Screening / economics*
  • Mass Screening / statistics & numerical data*
  • Medication Systems, Hospital / economics*
  • Medication Systems, Hospital / statistics & numerical data*
  • Single-Blind Method