Usefulness of STOPP/START criteria to assess appropriateness of medicines prescribed to older adults in a resource-limited setting

Abstract

Background There is a dearth of published data from resource-limited settings on appropriateness of medicines in older adults using explicit criteria, but it is unclear if the STOPP/START criteria can be helpful. Objective To assess the usefulness of STOPP/START criteria in assessing appropriateness of medicines in a resource-limited setting. Setting Medical, diabetic and psychiatric clinics of a tertiary care hospital and elderly living in a selected locality in Colombo district. Method A descriptive cross-sectional study was conducted over a 2 months period among adults > 60 years on long-term medicines. ‘Screening tool of older person’s prescriptions’ (STOPP) and ‘screening tool to alert doctors to right treatment’ (START) criteria were used to assess appropriateness of medicines. Main outcome measures Potentially inappropriate medicines (PIMs) and potential prescription omissions (PPOs). Results A total of 468 patients prescribed with 2841 medicines were analysed. PIMs were seen among 167 (35.7%) patients, while PPOs were seen among 289 (61.8%) patients. Incomplete documentation in health records, especially the absence of renal function status (53.7%), was a barrier for accurate assessment of PIMs and PPOs. Some criteria could not be assessed due to differences in the healthcare settings and resources available. Conclusions Inappropriate prescribing to older adults was a problem in the selected settings. Use of explicit criteria to detect inappropriate prescribing is important, but should be modified to suit the local context. Documentation in medical records should be improved to allow for better assessment of appropriateness of medicines.