Majority of drug-related problems identified during medication review are not associated with STOPP/START criteria.
Majority of drug-related problems identified during medication review are not associated with STOPP/START criteria.
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DOI：
10.1007/s00228-015-1908-x
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发表时间：
2015-10
影响因子：
2.9
通讯作者：
Bouvy ML
中科院分区：
文献类型：
--
作者：
Verdoorn S;Kwint HF;Faber A;Gussekloo J;Bouvy ML
STOPP和START标准识别潜在的不适当处方和潜在的处方遗漏。目前尚不清楚STOPP/START标准是否能识别所有与药物有关的问题。本研究旨在确定STOPP/START在多大程度上对应于完整临床药物审查期间发现的药物相关问题（DRPs）。在13家荷兰社区药房中，457名年龄≥ 65岁且使用≥ 5种药物的社区居民患者接受了完整的临床药物审查。社区药剂师确定潜在的DRP和建议的隐含标准。完成后，研究者将所有确定的DRP和建议与STOPP和START标准进行比较。社区药剂师在457例患者中确定的潜在DRP总数为1656例（平均每例患者3.6例）。81%的DRP与STOPP/START标准无关。在确定的DRP中，START标准的百分比高于STOPP标准的百分比（13%对5.7%，p <0.01）。与STOPP标准相关的建议的执行率高于START标准相关的建议（56 vs. 39%，p <0.01）。STOPP和START建议的执行率均低于与STOPP/START标准无关的建议（66%，p = 0.047和p <0.001）。这项研究表明，大多数社区老年患者的药物相关问题与STOPP/START标准无关。这些发现表明，在全面的临床药物审查中，STOPP/START标准的应用最好与隐含标准相结合。
STOPP and START criteria identify potential inappropriate prescribing and potential prescribing omissions. It is unknown whether STOPP/START criteria identify all drug-related problems. This study aims to determine to what extent STOPP/START correspond to drug-related problems (DRPs) identified during a full clinical medication review. In 13 Dutch community pharmacies, 457 community-dwelling patients aged ≥65 years and using ≥5 drugs, received a full clinical medication review. Community pharmacists identified potential DRPs and recommendations by implicit criteria. After completion, all identified DRPs and recommendations were compared with STOPP and START criteria by investigators. The total number of potential DRPs identified by community pharmacists was 1656 in 457 patients (mean 3.6 per patient). Eighty-one percent of DRPs were not associated with STOPP/START criteria. The percentage of START criteria present in identified DRPs was higher than the percentage of STOPP criteria (13 vs. 5.7 %, p < 0.01). The implementation rate for recommendations associated with STOPP criteria was higher compared to recommendations associated with START criteria (56 vs. 39 %, p < 0.01). Both implementation rates of STOPP and START recommendations were lower compared to recommendations not associated with STOPP/START criteria (66 %, p = 0.047 and p < 0.001, respectively). This study shows that the majority of drug-related problems of community-dwelling older patients was not associated with STOPP/START criteria. These findings suggest that application of STOPP/START criteria in full clinical medication review should preferably be combined with implicit criteria.