The STOPP / START Criteria
Some time ago, the notion of ‘potentially inappropriate drugs’ or PIMs was devised in attempts to identify medications that, in some cases, may be doing relatively more harm than good. In most cases, these involved individuals over the age of 65 years. These ‘culprit’ drugs are often associated with adverse drug events and a number of alternate drugs are available that can help mitigate the problem.
As such, a so-called ‘hit-list’ of potentially inappropriate medications (PIMs) was developed to this end. The Beers criteria were the result of this effort and were relatively successful in helping to reduce the number of PIMs in many individual drug profiles. But these criteria were not without shortcomings.
More recently, a more ‘robust’ set of criteria were published, better known as the STOPP / START criteria (Screening Tool of Older Person’s potentially inappropriate Prescriptions / Screening Tool to Alert doctors to Right Treatment). These were judiciously developed by a panel of experts from the fields of geriatrics and pharmacotherapy. (1)
Who should have a Medication Review / Triggers
Individuals most likely to benefit from a medication review include the following:
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The Medication Review Process
Essentially we use the 114 criteria from STOPP/START to analyze your medication profile. If PIMs are identied in your therapeutic profile, we highlight the problematic use involved with such agents as well as the clinical concern related with their use. We will also recommend therapeutic alternatives that are not known to be potentially inappropriate medications. The evaluation's objective is to reduce the risk of adverse drug related outcomes. All of our medication reviews are conducted by a licensed pharmacist. For more details about our Medication Review process, see 'ARMOR'
Why is a Medication Review Important
All individuals over the age of 65 years should give serious thought to having a Medication Review. It will help to optimize your drug therapy and may ultimately prevent an adverse drug event or possibly a hospitalization. Following are the principle reasons for having a medication review in the elderly:
Our medication review differs from one you might get from your local pharmacy. Most of these will focus on drug-drug interactions. There is nothing wrong with this type of evaluation but it falls short in terms of identifying conflicts in your therapeutic profile that may be causing or may have the potential to cause an adverse event.
In other words, a lack of drug interactions does not mean that some of the medications you are taking may be inappropriate (see 'Developing a false sense of security')
How often should I have a Medication Review
Annually is a good place to start. But it also depends on whether you have had recent changes to your medications (e.g. new medications, dosage changes, diagnosis of new medical condition) in which case you may want to have your medications reviewed. A recent hospital discharge is usually a good time also given that medications are often changed during a hospitalization. A medication review in the elderly is particularly important because they are greater risk of adverse drug events.
Key Factors & Questions taken into consideration in our Medication Reviews
- Is each drug in the profile still indicated for this individual?
2. Benefit and Appropriateness
- Do benefits continue to outweigh risks or harms? Which medications are considered high risk? (using STOPP criteria as our guide)
3. Prescribing cascade
- Is there a medication being used to treat the side effect of another existing drug in the individual's profile?
4. Duration of use
- Have the medication's benefits expired or are they possibly overextended? Is a drug being used beyond its clinically proven benefit period?
5. Life expectancy
- In cases of advanced age, can the drug's benefits be realized?
A sample Medication Review case study
A sample Medication Review case study
Following is a sample case study for a fictitious character we call Mr. Meds. We developed this sample case to better illustrate what you might expect from our Medication Reviews. Let us introduce you to Mr. Meds:
But Mr. Meds is also aware that the benefits he gets from his medications come with some risks. He also wonders whether his increasing age might play a role in how well he will tolerate his medications in the long-term.
Mr. Meds wakes up one morning and decides to surf the internet. He wonders whether his medication profile could be reviewed in efforts to optimize the medications he is taking. Fortunately for him, he lands on the AskaPharm Medication Reviews website and decides to submit his therapeutic profile information:
After receiving and having a look at his Medication Review Recommendations, Mr. Meds puts the report aside until he meets with his treating physician. A few weeks pass, and Mr. Meds discusses the medication review with his doctor. His physician takes note of the recommendations and decides to make a few adjustments to the Mr. Meds' treatment. New alternate medications are prescribe to replace the drugs that were identified as 'potentially inapproprate medications'.
the days that follow...
Mr. Meds now feels less sedated and as a result is less likely to experience another fall. His breathing also seems to have improved because his new blood pressure medication has fewer negative effects on his breathing capacity. Thanks to a medication review, Mr. Meds has improved his wellbeing and has potentially prevented an adverse drug event.