Aims: The aim of the study was to evaluate quality of drug prescribing during the stay in a geriatric day clinic using the START / STOPP version 2 criteria (START stands for Screen Tool to Alert doctors to Right Treatment, and STOPP stands for Screening Tool for Older Persons’ potentially inappropriatePrescriptions).
Methods: The retrospective longitudinal study included 193 patients with the diagnoses pain and/or dementia and/or depression; assessment was conducted on admission and before discharge using a modified application of the START criteria focusing on actual implementation of START criteria. In parallel, STOPP criteria were specified with the help of information from patient information leaflets (PILs) and a German online pharma index.
Results: Due to the administration of vitamin D and calcium, and increasing analgesic and antidepressant therapy, a highly significant mean increase (T=-6,57; p<.001) of 0.65 fulfilled START criteria per patient was observed during the treatment period. Regarding the fulfilment of STOPP criteria, the comparison of mean values shows a slight increase of 0.02 criteria per patient, which, however, is not significant (T=-.16; p=.875). Although a decrease of potentially inappropriate medication (PIM) could be achieved, no significant change was observed with regard to the STOPP criteria. The prevalence of PIM decreased from 82.9% on admission to 81.4% at discharge, whereas polypharmacy increased from 85.5% to 90.7%. The average number of diagnoses rose from 13.0 to 14.0 (T=-.16; p=.875). Both number of diagnoses and medications had a highly significant positive pearson correlation with implemented or fulfilled START /STOPP Criteria. This became particularly evident with the diagnoses of pain and depression.
The increased quality of medicinal treatment is evident by (i) the high values of implemented STARTs, (ii) constant STOPPs with increasing medication during the treatment, and (iii) absolute growth in indicated STOPPs with a reduction in non-indicated medication.
Conclusion: The quality of drug prescription is improved through utilizing START/STOPP criteria making them appropriate for optimizing pharmacotherapy; however, these criteria should be critically examined in the future with the help of the modified START methodology.