What does a short article mean? In the live version of the Geriatric Medicine Journal Club held at the University of Toronto, the last 15 minutes of the hour is devoted to the presentation and discussion of the article.
When to start and when to stop. Potentially inappropriate prescriptions (PIPs) occur when the risks associated with prescribing a medication outweigh the potential benefits of that medication. Does this use of validated criteria for PIP, such as the Screening Tool of Older Person's potentially inappropriate Prescriptions and Screening Tool to Alert doctors to Right Treatment (STOPP/START) in chronic geriatric facilities result in clinically meaningful outcomes?
Frankenthal D1, Lerman Y, Kalendaryev E, Lerman Y. Intervention with the screening tool of older persons potentially inappropriate prescriptions/screening tool to alert doctors to right treatment criteria in elderly residents of a chronic geriatric facility: a randomized clinical trial. J Am Geriatr Soc. 2014 Sep;62(9):1658-65.
The article can be found here: and the abstract is posted below.
Engage in the discussion on Twitter on December 19, 2014 at 08:00 EST / 13:00 GMT and don't forget to use the hashtag #GeriMedJC.
OBJECTIVES: To assess the effect of a Screening Tool of Older Persons potentially inappropriate Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) medication intervention on clinical and economic outcomes.
DESIGN: Parallel-group randomized trial.
SETTING: Chronic care geriatric facility.
PARTICIPANTS: Residents aged 65 and older prescribed with at least one medication (N = 359) were randomized to receive usual pharmaceutical care or undergo medication intervention.
INTERVENTION: Screening medications with STOPP/START criteria followed up with recommendations to the chief physician.
MEASUREMENTS: The outcome measures assessed at the initiation of the intervention and 1 year later were number of hospitalizations and falls, Functional Independence Measure (FIM), quality of life (measured using the Medical Outcomes Study 12-item Short-Form Health Survey), and costs of medications.
RESULTS: The average number of drugs prescribed was significantly lower in the intervention than in the control group after 1 year (P < .001). The average drug costs in the intervention group decreased by 103 shekels (US$29) per participant per month (P < .001). The average number of falls in the intervention group dropped significantly (P = .006). Rates of hospitalization, FIM scores, and quality of life measurements were similar for both groups.
CONCLUSION: Implementation of STOPP/START criteria reduced the number of medications, falls, and costs in a geriatric facility. Their incorporation in those and similar settings is recommended.
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