title: Effectiveness of the STOPP/START (Screening Tool of Older Persons' potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment) criteria: systematic review and meta-analysis of randomized controlled studies.
abstract: OBJECTIVE
  STOPP/START are explicit screening tools that identify potentially inappropriate prescribing in older adults. Our objective was to update our 2013 systematic review that showed limited evidence of impact, using new evidence from randomized controlled trials (RCTs) assessing clinical, humanistic and economic outcomes in older adults.
  
  
  METHODS
  We performed a search of PubMed, EMBASE, CINAHL, Web of Science and grey literature for RCTs published in English since the previous review through June 2014. The Cochrane Risk of Bias Tool was used. We performed a meta-analysis on the effect of STOPP on potentially inappropriate medication (PIM) rates and a narrative synthesis on other outcomes.
  
  
  CONCLUSIONS
  Four RCTs (n = 1925 adults) from four countries were included, reporting both acute (n = 2) and long-term care (n = 2) patients. Studies differed in implementation. Two studies were judged to have low risk, and two to have moderate-to-high risk of bias in key domains. Meta-analysis found that the STOPP criteria reduced PIM rates in all four studies, but study heterogeneity (I(2) = 86·7%) prevented the calculation of a meaningful statistical summary. We found evidence that use of the criteria reduces falls, delirium episodes, hospital length-of-stay, care visits (primary and emergency) and medication costs, but no evidence of improvements in quality of life or mortality.
  
  
  CONCLUSIONS
  STOPP/START may be effective in improving prescribing quality, clinical, humanistic and economic outcomes. Additional research investigating these tools is needed, especially in frail elderly and community-living patients receiving primary care.
authors.affiliation: College of Pharmacy, Faculty of Health Professions, Dalhousie University, Halifax, NS, Canada.
authors.forename: B
authors.initials: B
authors.lastname: Hill-Taylor
authors.affiliation: Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.|Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.
authors.forename: K A
authors.initials: KA
authors.lastname: Walsh
authors.affiliation: Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Stewart
authors.affiliation: Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Hayden
authors.affiliation: Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
authors.forename: S
authors.initials: S
authors.lastname: Byrne
authors.affiliation: College of Pharmacy, Faculty of Health Professions, Dalhousie University, Halifax, NS, Canada.
authors.forename: I S
authors.initials: IS
authors.lastname: Sketris
mesh_terms: D011307:Drug Prescriptions; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D008403:Mass Screening / Q000379:methods*; D010820:Physicians; D000067561:Potentially Inappropriate Medication List; D011320:Primary Health Care / Q000379:methods*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic
keywords: STOPP; STOPP and START; potentially inappropriate medications; potentially prescribing omissions; prescribing practice