Identification of inappropriate prescribing in geriatrics at a Veterans Affairs hospital using STOPP/START screening tools

Abstract

Objective: Pharmacists' interventions of potentially inappropriate medications (PIM) decrease hospital admissions and emergency department visits and provide health-cost savings. The newest criterion to address PIMs is STOPP/START (Screening Tool of Older Person's Prescriptions/Screening Tool to Alert Doctor's to the Right Treatment). The purpose of this study is to determine the frequency of PIMs in a geriatric population.

Design/setting/participants: A retrospective chart review of 511 patients was conducted at a Veterans Affairs hospital in patients > 70 years of age.

Interventions: Charts were reviewed at hospital admission, discharge, and first follow-up clinic visit post-discharge for incidence of STOPP/START medications.

Main outcome measure(s): STOPP/START criterion was applied to patients' medication lists and documented with omission or commission medications.

Results: One hundred eleven (22%) patients met inclusion criteria. STOPP/START medication use was similar at all time points. Medications without an appropriate diagnosis were the most common type of STOPP criteria identified. Aspirin (> 150 mg daily) had high frequency of use. Incidence of START was highest with omissions of statin therapy, angiotensin-converting enzyme (ACE) inhibitor with heart failure, and vitamin D in patients with osteoporosis.

Conclusion: The results demonstrated that inappropriate prescribing and omission of medications occurs consistently at all points of care. STOPP/START criteria are more comprehensive than previous inappropriate prescribing lists. Utilization of a clinical pharmacist would benefit patients through elimination of PIMs and identification of medications to optimize patient care.