title: Application of STOPP and START criteria: interrater reliability among pharmacists.
abstract: BACKGROUND
  Inappropriate prescribing is a well-documented problem in older people. The new screening tools, STOPP (Screening Tool of Older Peoples' Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) have been formulated to identify potentially inappropriate medications (PIMs) and potential errors of omissions (PEOs) in older patients. Consistent, reliable application of STOPP and START is essential for the screening tools to be used effectively by pharmacists.
  
  
  OBJECTIVE
  To determine the interrater reliability among a group of clinical pharmacists in applying the STOPP and START criteria to elderly patients' records.
  
  
  METHODS
  Ten pharmacists (5 hospital pharmacists, 5 community pharmacists) were given 20 patient profiles containing details including the patients' age and sex, current medications, current diagnoses, relevant medical histories, biochemical data, and estimated glomerular filtration rate. Each pharmacist applied the STOPP and START criteria to each patient record. The PIMs and PEOs identified by each pharmacist were compared with those of 2 academic pharmacists who were highly familiar with the application of STOPP and START. An interrater reliability analysis using the kappa statistic (chance corrected measure of agreement) was performed to determine consistency between pharmacists.
  
  
  RESULTS
  The median kappa coefficients for hospital pharmacists and community pharmacists compared with the academic pharmacists for STOPP were 0.89 and 0.88, respectively, while those for START were 0.91 and 0.90, respectively.
  
  
  CONCLUSIONS
  Interrater reliability of STOPP and START tools between pharmacists working in different sectors is good. Pharmacists working in both hospitals and in the community can use STOPP and START reliably during their everyday practice to identify PIMs and PEOs in older patients.
authors: School of Pharmacy, University College Cork, Cork, Republic of Ireland. cristin.ryan@ucc.ie
authors: Cristin
authors: C
authors: Ryan
authors: Denis
authors: D
authors: O'Mahony
authors: Stephen
authors: S
authors: Byrne
mesh_terms: D000368:Aged; D003157:Community Pharmacy Services / Q000458:organization & administration; D004347:Drug Interactions; D017723:Drug Utilization Review / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D015588:Observer Variation; D010595:Pharmacists / Q000592:standards*; D010607:Pharmacy Service, Hospital / Q000458:organization & administration; D010818:Practice Patterns, Physicians' / Q000592:standards*; D055553:Prescription Drugs / Q000008:administration & dosage / Q000009:adverse effects; D015203:Reproducibility of Results
chemical_list: D055553:Prescription Drugs