ABSTRACT
BACKGROUND: The rapid digitalization of medical practice has attracted growing interest in developing software applications for clinical guidelines and explicit screening tools to detect potentially inappropriate prescribing, such as STOPP/START criteria. The aim of the current study was to develop and provide logically unambiguous algorithms of STOPP/START criteria version 2, encoded with international disease and medication classification codes, to facilitate the development of software applications for multiple purposes. METHODS: A four round multidisciplinary consensus and validation procedure was conducted to develop implementable coded algorithms for software applications of STOPP/START criteria version 2, based on ICD, ICPC, LOINC and ATC classification databases. RESULTS: Consensus was reached for all 34 START criteria and 76 out of 80 STOPP criteria. The resulting 110 algorithms, modeled as inference rules in decision tables, are provided as supplementary data. CONCLUSION: This is the first study providing implementable algorithms for software applications based on STOPP/START version 2, validated in a computer decision support system. These algorithms could serve as a template for applying STOPP/START criteria version 2 to any software application, allowing for adaptations of the included ICD, ICPC and ATC codes and changing the cut-off levels for laboratory measurements to match local guidelines or clinical expertise.
Subject(s)
Algorithms , Consensus , Inappropriate Prescribing , Software , Aged , Databases, Factual , Female , Humans , Male , Practice Patterns, Physicians'/standardsABSTRACT
BACKGROUND: the STOPP/START criteria are a promising framework to increase appropriate prescribing in the elderly in clinical practice. However, the current definitions of the STOPP/START criteria are rather non-specific, allowing undesirable variations in interpretation and thus application. The aim of this study was to design specifications of the STOPP/START criteria into international disease and medication codes to facilitate computerised extraction from medical records and databases. METHODS: a three round consensus procedure with a multidisciplinary expert panel was organised to prepare, judge and agree on the design of the STOPP/START criteria specifications in corresponding international disease codes (ICD9 and ICPC) and medication codes (ATC). RESULTS: after two rounds consensus was reached for 74% of the STOPP criteria and for 73% of the START criteria. After three rounds full consensus was reached resulting in a specification of 61 out of 62 STOPP criteria and 26 START criteria with their corresponding codes. One criterion could not be specified and for some criteria corresponding disease codes were lacking or imperfect. CONCLUSION: this study showed the necessity of a consensus procedure as even experts frequently differed on how to specify the STOPP/START criteria. This specification enables next steps such as prognostic validation of these criteria on adverse outcomes and studying the impact of improving appropriate prescribing in the elderly.
Subject(s)
Drug-Related Side Effects and Adverse Reactions/prevention & control , Inappropriate Prescribing/prevention & control , Interdisciplinary Communication , International Classification of Diseases , Pharmaceutical Preparations/classification , Practice Patterns, Physicians' , Primary Health Care/classification , Surveys and Questionnaires/standards , Age Factors , Checklist , Consensus , Databases, Factual , Drug-Related Side Effects and Adverse Reactions/etiology , Guideline Adherence , Humans , Pharmaceutical Preparations/standards , Practice Guidelines as Topic , Practice Patterns, Physicians'/standards , Primary Health Care/standards , Reproducibility of Results , Risk Factors , Terminology as TopicABSTRACT
Many drugs that can be prescribed safely and effectively to younger patients are potentially inappropriate for the elderly as a result of physiological changes and increased comorbidity. A screening tool can be useful for detecting potentially inappropriate medication use in the elderly. When analysing medication use in the elderly, both overtreatment and undertreatment should be assessed. In Ireland, a screening method called the STOPP and START criteria has been developed; these provide 'handles' for the detection of potential overtreatment and undertreatment. The STOPP and START criteria, therefore, seem to be more fitting to the Dutch situation than the widely used Beers' criteria. In the new Dutch multidisciplinary guideline, 'Polypharmacy in the elderly' the use of the STOPP and START criteria is advised. In this article, we present a translation of the STOPP and START criteria which has been adapted for Dutch practice.
