Introduction: START (Screening Tool to Alert doctors to Right Treatment) and STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions) are two validated tools for evaluation of medication appropriateness in the elderly.
The aim of this study was to examine the feasibility of these criteria in Belgian general practice and to evaluate the changes as proposed by these tools for a selection of medication profiles.
Method: We randomly selected a predefined number of medical files of patients aged 65 or more and being prescribed five or more medications, from three different general practices in Belgium. Medication profiles and medical history were extracted from the electronic medical records and the START-STOPP criteria were applied. A qualitative and quantitative evaluation of the proposed medication changes was performed.
Results: From each practice, 30 medical files were analyzed. Mean age of the patients was 75 years (65-95); gender distribution was equal. A total of 705 medications were prescribed in the study population (average: 7.8).
According to the START-STOPP criteria, adjustment of medication would be necessary in 67.8% of the study population, which would reduce the average number of medications taken to 7.4 per patient.
Application of the START criteria would result in the administration of 0.45 new medications per patient (range 0-2). When using the STOPP criteria a mean number of 0.94 medications could be stopped (range 0-6).
Application of the criteria was feasible and took by average 4.5 min per patient. Time needed to extract the necessary information (i.e. medication list, active problem list, biochemistry) from the electronic medical file, however, was 20 minutes per patient.
Conclusion: The START-STOPP criteria are a valuable tool for the medication management of elderly patients and can be used by the general practitioner. A well organized electronic medical record is indispensible for this.