276 CHAPTER 4.1 Abstract Introduction The STOPP/START instrument is a screening tool to evaluate the appropriateness of medication in older people. STOPP/START criteria have been converted into software algorithms and implemented in a clinical decision support system (CDSS) to facilitate their use in clinical practice. The objective of this study was to determine the frequency of CDSS-generated STOPP/START signals and subsequent acceptance by a pharmacotherapy team in a hospital setting. Methods Hospitalised older patients with polypharmacy and multimorbidity allocated to the intervention arm of the (OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly) trial received a CDSS-assisted structured medication review in four European hospitals. We evaluated the frequency of CDSS-generated STOPP/START signals and the subsequent acceptance of these signals by a trained pharmacotherapy team consisting of a physician and pharmacist after evaluation of clinical applicability to the individual patient, prior to discussing pharmacotherapy optimisation recommendations with the patient and attending physicians. Multivariate linear regression analysis was used to investigate potential patient-related (e.g. age, number of co-morbidities and medications) and settingrelated (e.g. ward type, country of inclusion) determinants for acceptance of STOPP and START signals. Results In 819/826 (99%) of the patients, at least one STOPP/START signal was generated using a set of 110 algorithms based on STOPP/START v2 criteria. Overall, 39% of the 5080 signals were accepted by the pharmacotherapy team. There was a high variability in the frequency and the subsequent acceptance of the individual STOPP/ START criteria. The acceptance ranged from 2.5 to 75.8% for the top ten most frequently generated STOPP and START signals. The signal to stop a drug without a clinical indication was most frequently generated (28%), with more than half of the signals accepted (54%). No difference in mean acceptance of STOPP versus START signals was found. In multivariate analysis, most patient-related determinants did not predict acceptance, although the acceptance of START signals increased in patients with one or more hospital admissions (+ 7.9; 95% confidence interval [CI] 1.6–14.1) or one or more falls in the previous year (+ 7.1; 95% CI 0.7–13.4). A higher number of co-morbidities was associated with lower acceptance of STOPP (− 11.8%; 95% CI − 19.2 to − 4.5) and START (− 11.0%; 95% CI − 19.4 to − 2.6) signals for patients
RkJQdWJsaXNoZXIy MTk4NDMw