Seminar M1 – Inspired by STOPP/START: a new prescription screening tool for adult patients

 

Inappropriate prescribing (IP) is a cause of drug related problems (DRP) and possibly adverse drug reactions (ADR).

 

This has been of major concern for physicians and pharmacists and numerous surveys have been performed over the years to identify this issue. It is acknowledged that 3 to 5 % of hospitalisations are related to DRP and that the associated annual cost in USA is about 177 billion per year.

 

Prescribing is a key step. Different strategies have been developed to prevent this IP. For example, DRPs frequency may be reduced by pharmacotherapy optimisations, such as medication reviews led by pharmacists attending medical rounds. However, the pool of trained clinical pharmacists is often too small to cover all wards of a hospital, especially in most European countries. Thus, other strategies have to be explored to prevent IP, like screening tools, helping prescribers and pharmacists to review orders in a systematic manner. Among those, the STOPP/START (Screening Tool of Older Persons’ Prescriptions / Screening Tool to Alert doctors to Right Treatment) is one of the most widely used for the geriatric population. However, there is a lack of such screening tools dedicated to middle-aged patients (less than 65 years), who may suffer from multiple diseases or multiple comorbidities and, may receive multiple drugs, and thus may be at risk of DRPs.

 

An international project using Delphi consensus method was launched in 2013 in 4 French-speaking countries. A new screening tool inspired from STOPP/START and adapted to the middle-aged population hospitalised in general internal medicine was validated. It should provide to prescribers and pharmacists, helpful tools in screening for appropriate and potentially inappropriate medication.