1. Drugs Aging. 2014 Apr;31(4):291-8. doi: 10.1007/s40266-014-0157-5.

Reduction of potentially inappropriate medications using the STOPP criteria in
frail older inpatients: a randomised controlled study.

Dalleur O(1), Boland B, Losseau C, Henrard S, Wouters D, Speybroeck N, Degryse
JM, Spinewine A.

Author information: 
(1)Pharmacy Department, Cliniques universitaires Saint-Luc, Université catholique de
Louvain, Av. Hippocrate 10, 1200, Brussels, Belgium, olivia.dalleur@uclouvain.be.

BACKGROUND: Hospital admissions may provide an opportunity to discontinue
potentially inappropriate medications (PIMs) in older patients. Little is known
about the effect of using the Screening Tool of Older People's potentially
inappropriate Prescriptions (STOPP) in this context. This study aimed to test the
hypothesis that specific STOPP recommendations from an inpatient geriatric
consultation team (IGCT) to the hospital physician leads to reductions in PIMs
for patients at discharge.
METHODS: This was a randomised controlled study in 146 frail inpatients (in
2011). The intervention consisted of STOPP recommendations made by the IGCT to
ward physicians to discontinue PIMs, in addition to the standard geriatric
advice.
RESULTS: Intervention (n = 74) and control (n = 72) groups were similar in terms 
of patient characteristics (median age 85 years; median number of daily drugs,
seven) and PIM distribution (68 and 57 PIMs in 53 and 51 % of patients,
respectively). At discharge, the reduction in PIMs was twice as high for the
intervention group as for the control group (39.7 and 19.3 %, respectively;
p = 0.013). The proportion of patients who still had one or more PIM at discharge
did not differ between groups. In the 50 patients followed-up a year later, the
majority of PIMs that had been stopped during hospitalisation had not been
restarted after discharge (17/28; 61 %). The clinical relevance of PIMs
identified at baseline in those patients was considered major (29 %), moderate
(37 %), minor (5 %), deleterious (8 %), or not assessed (11 %). Discontinuation
rate was not associated with clinical importance.
CONCLUSION: Specific STOPP recommendations provided to hospital physicians
doubled the reduction of PIMs at discharge in frail older inpatients. To further 
improve the appropriateness of prescribing in older patients, clinicians should
focus on the STOPP criteria that are of major clinical importance, and general
practitioners should be actively involved.

PMID: 24566877  [PubMed - in process]