Frequentie en acceptatie van door beslisondersteuning gegenereerde STOPP/START-signalen bij ouderen met polyfarmacie en multimorbiditeit opgenomen in het ziekenhuis

Background The Screening Tool of Older Persons' Prescriptions (STOPP)/Screening Tool to Alert doctors to Right Treatment (START) instrument is a screening tool to evaluate the medication regimen 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 To determine the acceptance of CDSS generated STOPP/START signals by a pharmacotherapy team in hospitalised older patients with polypharmacy and multimorbidity. Design and methods Hospitalised multimorbid older patients with polypharmacy assigned to the Dutch intervention arm of the OPERAM (Optimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly) trial were included. Intervention patients received a CDSS-assisted structured medication review. The acceptance of CDSS-generated STOPP/START signals by a pharmacotherapy team and determinants for acceptance were evaluated. Results In 98% of the 203 included patients, at least one STOPP/START signal was generated. Overall, 43.1% of all 1059 signals were accepted. STOPP signals (51.5%) were more likely than START signals (39.1%) to be accepted per patient (mean difference: 12.4%; 95% confidence interval 4.7-20.1). A history of falls was positively associated with acceptance (+11.8%) while prior hospitalization (-10.7%), decreased renal function (-11.2%) and long hospital stay (-9.0%) were negatively associated with acceptance. Conclusion About half of the generated STOPP/START signals were accepted by the pharmacotherapy team. The nature of the signal was a better predictor for acceptance than patient or setting related factors.