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Clinical pharmacy and clinical trials (including case series)
STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) as a pharmacy service
  1. S. Armitage
  1. 1Midlands Regional Hospital Tullamore, Pharmacy, Tullamore, Ireland (Rep.)


Background In 2009 National Quality Standards for Residential Care Settings for Older people in Ireland were written into Irish legislation by the Health Information and Quality Authority (HIQA). Standard 15 specifically states that each resident on long-term medication in the Residential Care Setting should be reviewed by his/her medical practitioner on a three monthly basis, in conjunction with nursing staff and the pharmacist.

Purpose Implementation of STOPP and START1 as a clinical pharmacy service to facilitate three monthly medication reviews in an older residential care setting. Qualitative evaluation of the acceptability of the service to General Practitioners.

Materials and methods A total of 103 residents ≥65 years from two residential care units were eligible for inclusion (exclusion criteria included terminally ill or respite patients) in the study and six General Practitioners participated in the study. Each General Practitioner completed a qualitative post service evaluation interview to determine the acceptability of STOPP and START1 as a clinical pharmacy service.

Results Of the residents reviewed (n=103), 75 (72.8%) were female; the median age was 86 years (IQR: 66-103). 884 regular medicines were prescribed (Median 9). 75.7% (78) residents had at least one potentially inappropriate medicine (PIM) or prescribing omission identified by STOPP and START criteria1. 65% of potentially inappropriate prescribing involved use of medicines that had unfavourable risk benefit ratio according to STOPP and 34.8% were instances of PIM through omission of potentially beneficial medicine according to START. 46.6% (95) of recommendations were accepted and implemented by General Practitioners. Of all recommendations declined a valid reason was provided in 93.5% (102) of cases. All General Practitioners interviewed found STOPP/START1 to be acceptable as a clinical pharmacy service.

Conclusions Implementation of STOPP and START1 as a clinical pharmacy service reduces inappropriate prescribing, facilitates the three monthly medication reviews required to meet HIQA's medication monitoring and review standard and is acceptable to General Practitioners.

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