We’ve talked before about criteria for medications that are potentially inappropriate for use in older persons, such as the Beers criteria which is well known in homecare and long-term care communities. Researchers have proposed other criteria as a counter to the Beers lists due to somewhat of a backlash by medical providers about the criteria for a variety of reasons. My personal take is that prescribing of meds on the list has significantly reduced since its introduction. For example, when was the last time you saw meds like Dalmane and meprobamate prescribed?

The CHAMP team recently identified the STOPP (Screening Tool of Older Persons’ Prescriptions) and asked if I think it would be appropriate for home care professionals in the US to know about it.  As so often happens, this query had a peculiar synchronicity, as I had just reviewed the criteria for my “day job” with Partners In Care Foundation’s (CA) HomeMeds program.  The idea behind the STOPP criteria is that these are medications to avoid in patients with certain clinical conditions or at specified doses due lack of evidence of efficacy. An example of the latter is aspirin at dose > 150mg day (increased bleeding risk, no evidence for increased efficacy).

The STOPP researchers recently published a study in Archives of Internal Medicine that assessed if the potentially inappropriate medicines defined by the STOPP criteria are significantly associated with adverse drug events (ADEs) in older people with acute illness vs the Beers criteria. Previous studies have not demonstrated a consistent association of PIMs as defined by Beers criteria and avoidable ADEs. The study concluded that the STOPP criteria, unlike Beers criteria, are significantly associated with avoidable ADEs in older people that cause or contribute to urgent hospitalization.

This certainly resonates with the current focus on avoiding re-hospitalization. You might want to take a look at the STOPP tool, especially if working with a partner hospital to reduce ER/hospital admissions related to ADEs or other relevant QI efforts. Another related screening tool is START (screening tool to alert doctors to the right treatment), used to detect prescribing omissions in elderly patients.

Let us know what you think about these tools, and if you think they have value for your agency’s meds management efforts. In September…after vacation! Happy summer.
Click here to view the STOPP study abstract.

Dennee Frey, CHAMP Pharmacy Consultant