337 Hospital physicians’ and older patients’ agreement with individualised STOPP/START recommendations Reasons for disagreement with recommendations From the total of 371 STOPP/START recommendations that were discussed with both patient and attending physician, 143 (38.5%) were not agreed upon with ‘patient does not agree’ being the most prevalent documented reason for disagreement (39.9%). Themajority of recommendations to discontinue drugs for acid related disorders (N=61; of which 95.1% involved PPIs) were agreed upon (73.8%, Figure 5). Disagreement within this drug class occurred in 31% due to reluctance to discontinue by the patient, mainly relating to previous ineffective attempts to discontinue the medication. In another 31% of recommendations, the medication adjustment decision was deferred to the patient’s GP. In 19% of recommendations, they were no longer applicable at the time of discussion, indicating that new information had emerged during the discussion that was not present in the patient’s medical records. The remaining 19% of nonagreed recommendations were defined as ‘other’ or ‘unknown’ reason. Within the psychotropic medication group, 49 recommendations involved stopping benzodiazepines or Z-drugs. Of these, 27 recommendations (55.1%) were agreed upon by both patient and physician. Disagreement, when it occurred, was in the great majority (90.9%) due to reluctance to discontinue by the patient. The most common reasons given were chronic use without side-effects (falls or sleepiness) and self-reported dependence by patients. Recommendations to start osteoporosis drugs (N=67) were agreed upon by both patient and physician in 74.3% of cases. Reasons for disagreement included recommendation no longer applicable (41%) based on new information obtained during discussion with patient/physician, patient not agreeing (35%) based on lack of motivation to take more tablets, and patient preference to discuss the matter with their GP rather than stopping in hospital. For 12 recommendations (18%), the decision was deferred to the GP and in the remaining 4 recommendations (6%), the reason for disagreement was unknown. Medication within the cardiovascular & antithrombotic agents group contained both START recommendations (N=48) and STOPP recommendations (N=35) with identical mean levels of agreement for both categories i.e. 54%. In cases of disagreement, the most important reason was ‘physician does not agree or does not feel qualified to advise’ (30%). In 24% of recommendations, the decision was deferred to the GP. In 19% of recommendations, the reason was ‘patient does not agree’. In 5%, the recommendation was no longer applicable and in 22% other reasons were applicable or the reason was not known. 4
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