Key result
Orally communicated medication recommendations based on STOPP/START criteria yielded fewer potentially inappropriate prescriptions than written review at 24 months (33.3% vs 48.4%, P=0.02).
Why the study?
Does an orally communicated medication intervention based on STOPP/START criteria improve prescribing quality and clinical outcomes compared to written medication review in geriatric facility residents?
Cohort (n=306)
No
Does an orally communicated medication intervention based on STOPP/START criteria improve prescribing quality and clinical outcomes compared to written medication review in geriatric facility residents?
Absolute Event Rate: 33.3% vs 48.4%
p-value: p=0.02
Orally communicated medication interventions using STOPP/START criteria maintain long-term reductions in potentially inappropriate prescriptions and medication costs compared to written reviews in geriatric facilities.
OBJECTIVES: To compare 24-month outcomes of participants of a prospective randomized controlled trial (RCT) assigned to undergo a medication intervention of orally communicated recommendations based on Screening Tool of Older Persons potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert Doctors to Right Treatment (START) (intervention group) with outcomes of those assigned to undergo written medication review (control group). DESIGN: Retrospective cohort study. SETTING: Chronic care geriatric facility. PARTICIPANTS: Of 359 participants from a prospective RCT conducted between April 2012 and September 2013, 306 were evaluable for another 12-month follow-up. MEASUREMENTS: Outcomes at 24-month follow-up included quality of prescribing (assessed according to STOPP/START), hospitalizations, falls, costs of medications, and all-cause mortality. Outcomes were compared with those reported at the beginning (baseline) and end (12-month follow-up) of the RCT. RESULTS: There was a significant rise in potentially inappropriate prescriptions (PIPs) (P = .01) and potentially prescriptions omissions (PPOs) (P < .001) in the intervention group between 12 and 24 months, although the prevalence of PIPs was significantly lower in the intervention group (33.3%) than the control group (48.4%) at 24-month follow-up (P = .02). Costs of medications were significantly lower in the intervention group than the control group (P < .001) at 24-month follow-up. The average number of falls in both groups dropped significantly between baseline and study closure (P = .04 and P = .008, respectively). There was no significant difference in hospitalizations and mortality between the two groups at 24-month follow-up. CONCLUSION: The effect of an orally communicated medication intervention with the STOPP/START criteria on falls was maintained over time. Direct communication between pharmacists and prescribing physicians is more efficient than written medication review and is recommended every 6 months in geriatric facilities.
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Frankenthal et al. (2016) conducted a cohort in Geriatric facility residents (n=306). Orally communicated medication recommendations based on STOPP/START vs. Written medication review was evaluated on Prevalence of potentially inappropriate prescriptions (PIPs) (p=0.02). Orally communicated medication recommendations based on STOPP/START criteria yielded fewer potentially inappropriate prescriptions than written review at 24 months (33.3% vs 48.4%, P=0.02).
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