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Frequency and Acceptance of Clinical Decision Support System-Generated STOPP/START Signals for Hospitalised Older Patients with Polypharmacy and Multimorbidity
BACKGROUND: The Screening Tool of Older Persons’ Prescriptions (STOPP)/Screening Tool to Alert to Right Treatment (START) instrument is used to evaluate the appropriateness of medication in older people. STOPP/START criteria have been converted into software algorithms and implemented in a clinical...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8752546/ https://www.ncbi.nlm.nih.gov/pubmed/34877629 http://dx.doi.org/10.1007/s40266-021-00904-z |
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author | Sallevelt, Bastiaan T. G. M. Huibers, Corlina J. A. Heij, Jody M. J. Op Egberts, Toine C. G. van Puijenbroek, Eugène P. Shen, Zhengru Spruit, Marco R. Jungo, Katharina Tabea Rodondi, Nicolas Dalleur, Olivia Spinewine, Anne Jennings, Emma O’Mahony, Denis Wilting, Ingeborg Knol, Wilma |
author_facet | Sallevelt, Bastiaan T. G. M. Huibers, Corlina J. A. Heij, Jody M. J. Op Egberts, Toine C. G. van Puijenbroek, Eugène P. Shen, Zhengru Spruit, Marco R. Jungo, Katharina Tabea Rodondi, Nicolas Dalleur, Olivia Spinewine, Anne Jennings, Emma O’Mahony, Denis Wilting, Ingeborg Knol, Wilma |
author_sort | Sallevelt, Bastiaan T. G. M. |
collection | PubMed |
description | BACKGROUND: The Screening Tool of Older Persons’ Prescriptions (STOPP)/Screening Tool to Alert to Right Treatment (START) instrument is used 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. OBJECTIVE: Our objective was to determine the frequency of CDSS-generated STOPP/START signals and their subsequent acceptance by a pharmacotherapy team in a hospital setting. DESIGN AND METHODS: Hospitalised older patients with polypharmacy and multimorbidity allocated to the intervention arm of the OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly) trial underwent 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 setting-related (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 with more than nine and between seven and nine co-morbidities, respectively. For setting-related determinants, the acceptance differed significantly between the participating trial sites. Compared with Switzerland, the acceptance was higher in Ireland (STOPP: + 26.8%; 95% CI 16.8–36.7; START: + 31.1%; 95% CI 18.2–44.0) and in the Netherlands (STOPP: + 14.7%; 95% CI 7.8–21.7). Admission to a surgical ward was positively associated with acceptance of STOPP signals (+ 10.3%; 95% CI 3.8–16.8). CONCLUSION: The involvement of an expert team in translating population-based CDSS signals to individual patients is essential, as more than half of the signals for potential overuse, underuse, and misuse were not deemed clinically appropriate in a hospital setting. Patient-related potential determinants were poor predictors of acceptance. Future research investigating factors that affect patients’ and physicians’ agreement with medication changes recommended by expert teams may provide further insight for implementation in clinical practice. REGISTRATION: ClinicalTrials.gov Identifier: NCT02986425. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40266-021-00904-z. |
format | Online Article Text |
id | pubmed-8752546 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-87525462022-01-20 Frequency and Acceptance of Clinical Decision Support System-Generated STOPP/START Signals for Hospitalised Older Patients with Polypharmacy and Multimorbidity Sallevelt, Bastiaan T. G. M. Huibers, Corlina J. A. Heij, Jody M. J. Op Egberts, Toine C. G. van Puijenbroek, Eugène P. Shen, Zhengru Spruit, Marco R. Jungo, Katharina Tabea Rodondi, Nicolas Dalleur, Olivia Spinewine, Anne Jennings, Emma O’Mahony, Denis Wilting, Ingeborg Knol, Wilma Drugs Aging Original Research Article BACKGROUND: The Screening Tool of Older Persons’ Prescriptions (STOPP)/Screening Tool to Alert to Right Treatment (START) instrument is used 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. OBJECTIVE: Our objective was to determine the frequency of CDSS-generated STOPP/START signals and their subsequent acceptance by a pharmacotherapy team in a hospital setting. DESIGN AND METHODS: Hospitalised older patients with polypharmacy and multimorbidity allocated to the intervention arm of the OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly) trial underwent 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 setting-related (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 with more than nine and between seven and nine co-morbidities, respectively. For setting-related determinants, the acceptance differed significantly between the participating trial sites. Compared with Switzerland, the acceptance was higher in Ireland (STOPP: + 26.8%; 95% CI 16.8–36.7; START: + 31.1%; 95% CI 18.2–44.0) and in the Netherlands (STOPP: + 14.7%; 95% CI 7.8–21.7). Admission to a surgical ward was positively associated with acceptance of STOPP signals (+ 10.3%; 95% CI 3.8–16.8). CONCLUSION: The involvement of an expert team in translating population-based CDSS signals to individual patients is essential, as more than half of the signals for potential overuse, underuse, and misuse were not deemed clinically appropriate in a hospital setting. Patient-related potential determinants were poor predictors of acceptance. Future research investigating factors that affect patients’ and physicians’ agreement with medication changes recommended by expert teams may provide further insight for implementation in clinical practice. REGISTRATION: ClinicalTrials.gov Identifier: NCT02986425. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40266-021-00904-z. Springer International Publishing 2021-12-08 2022 /pmc/articles/PMC8752546/ /pubmed/34877629 http://dx.doi.org/10.1007/s40266-021-00904-z Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc/4.0/Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Original Research Article Sallevelt, Bastiaan T. G. M. Huibers, Corlina J. A. Heij, Jody M. J. Op Egberts, Toine C. G. van Puijenbroek, Eugène P. Shen, Zhengru Spruit, Marco R. Jungo, Katharina Tabea Rodondi, Nicolas Dalleur, Olivia Spinewine, Anne Jennings, Emma O’Mahony, Denis Wilting, Ingeborg Knol, Wilma Frequency and Acceptance of Clinical Decision Support System-Generated STOPP/START Signals for Hospitalised Older Patients with Polypharmacy and Multimorbidity |
title | Frequency and Acceptance of Clinical Decision Support System-Generated STOPP/START Signals for Hospitalised Older Patients with Polypharmacy and Multimorbidity |
title_full | Frequency and Acceptance of Clinical Decision Support System-Generated STOPP/START Signals for Hospitalised Older Patients with Polypharmacy and Multimorbidity |
title_fullStr | Frequency and Acceptance of Clinical Decision Support System-Generated STOPP/START Signals for Hospitalised Older Patients with Polypharmacy and Multimorbidity |
title_full_unstemmed | Frequency and Acceptance of Clinical Decision Support System-Generated STOPP/START Signals for Hospitalised Older Patients with Polypharmacy and Multimorbidity |
title_short | Frequency and Acceptance of Clinical Decision Support System-Generated STOPP/START Signals for Hospitalised Older Patients with Polypharmacy and Multimorbidity |
title_sort | frequency and acceptance of clinical decision support system-generated stopp/start signals for hospitalised older patients with polypharmacy and multimorbidity |
topic | Original Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8752546/ https://www.ncbi.nlm.nih.gov/pubmed/34877629 http://dx.doi.org/10.1007/s40266-021-00904-z |
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