title: Majority of drug-related problems identified during medication review are not associated with STOPP/START criteria.
abstract: OBJECTIVE
  STOPP and START criteria identify potential inappropriate prescribing and potential prescribing omissions. It is unknown whether STOPP/START criteria identify all drug-related problems. This study aims to determine to what extent STOPP/START correspond to drug-related problems (DRPs) identified during a full clinical medication review.
  
  
  METHODS
  In 13 Dutch community pharmacies, 457 community-dwelling patients aged ≥65 years and using ≥5 drugs, received a full clinical medication review. Community pharmacists identified potential DRPs and recommendations by implicit criteria. After completion, all identified DRPs and recommendations were compared with STOPP and START criteria by investigators.
  
  
  RESULTS
  The total number of potential DRPs identified by community pharmacists was 1656 in 457 patients (mean 3.6 per patient). Eighty-one percent of DRPs were not associated with STOPP/START criteria. The percentage of START criteria present in identified DRPs was higher than the percentage of STOPP criteria (13 vs. 5.7%, p < 0.01). The implementation rate for recommendations associated with STOPP criteria was higher compared to recommendations associated with START criteria (56 vs. 39%, p < 0.01). Both implementation rates of STOPP and START recommendations were lower compared to recommendations not associated with STOPP/START criteria (66%, p = 0.047 and p < 0.001, respectively).
  
  
  CONCLUSIONS
  This study shows that the majority of drug-related problems of community-dwelling older patients was not associated with STOPP/START criteria. These findings suggest that application of STOPP/START criteria in full clinical medication review should preferably be combined with implicit criteria.
authors.affiliation: Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), 3584 CG, Utrecht, The Netherlands. s.verdoorn@stevenshof.nl.|SIR Institute for Pharmacy Practice and Policy, 2331 JE, Leiden, The Netherlands. s.verdoorn@stevenshof.nl.
authors.forename: Sanne
authors.initials: S
authors.lastname: Verdoorn
authors.affiliation: Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), 3584 CG, Utrecht, The Netherlands.|SIR Institute for Pharmacy Practice and Policy, 2331 JE, Leiden, The Netherlands.
authors.forename: Henk-Frans
authors.initials: HF
authors.lastname: Kwint
authors.affiliation: SIR Institute for Pharmacy Practice and Policy, 2331 JE, Leiden, The Netherlands.
authors.forename: Adrianne
authors.initials: A
authors.lastname: Faber
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZD, Leiden, The Netherlands.
authors.forename: Jacobijn
authors.initials: J
authors.lastname: Gussekloo
authors.affiliation: Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), 3584 CG, Utrecht, The Netherlands.|SIR Institute for Pharmacy Practice and Policy, 2331 JE, Leiden, The Netherlands.
authors.forename: Marcel L
authors.initials: ML
authors.lastname: Bouvy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003157:Community Pharmacy Services / Q000458:organization & administration* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control* / Q000706:statistics & numerical data*; D008297:Male; D009426:Netherlands; D019338:Polypharmacy; D000067561:Potentially Inappropriate Medication List / Q000706:statistics & numerical data*
keywords: Drug-related problems; Elderly; Inappropriate prescribing; Medication review; Primary care; STOPP/START criteria