title: Prevention of Hospital-Acquired Adverse Drug Reactions in Older People Using Screening Tool of Older Persons' Prescriptions and Screening Tool to Alert to Right Treatment Criteria: A Cluster Randomized Controlled Trial.
abstract: To determine whether use of the Screening Tool of Older Persons' Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) criteria reduces incident hospital-acquired adverse drug reactions (ADRs), 28-day medication costs, and median length of hospital stay in older adults admitted with acute illness.
  
  
  
  Single-blind cluster randomized controlled trial (RCT) of unselected older adults hospitalized over a 13-month period.
  
  
  
  Tertiary referral hospital in southern Ireland.
  
  
  
  Consecutively admitted individuals aged 65 and older (N = 732).
  
  
  
  Single time point presentation to attending physicians of potentially inappropriate medications according to the STOPP/START criteria.
  
  
  
  The primary outcome was the proportion of participants experiencing one or more ADRs during the index hospitalization. Secondary outcomes were median length of stay (LOS) and 28-day total medication cost.
  
  
  
  One or more ADRs occurred in 78 of the 372 control participants (21.0%; median age 78, interquartile range (IQR) 72-84) and in 42 of the 360 intervention participants (11.7%; median age 80, IQR 73-85) (absolute risk reduction = 9.3%, number needed to treat = 11). The median LOS in the hospital was 8 days (IQR 4-14 days) in both groups. At discharge, median medication cost was significantly lower in the intervention group (€73.16, IQR €38.68-121.72) than in the control group (€90.62, IQR €49.38-162.53) (Wilcoxon rank test Z statistic = -3.274, P < .001).
  
  
  
  Application of STOPP/START criteria resulted in significant reductions in ADR incidence and medication costs in acutely ill older adults but did not affect median LOS.
authors.affiliation: Division of Geriatrics, Department of Medicine, University College Cork, Cork, Ireland.
authors.forename: Marie N
authors.initials: MN
authors.lastname: O'Connor
authors.affiliation: School of Pharmacy, University College Cork, Cork, Ireland.
authors.forename: David
authors.initials: D
authors.lastname: O'Sullivan
authors.affiliation: Division of Geriatrics, Department of Medicine, University College Cork, Cork, Ireland.|Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Gallagher
authors.affiliation: Health Research Board Clinical Research Facility, University College Cork, Cork, Ireland.
authors.forename: Joseph
authors.initials: J
authors.lastname: Eustace
authors.affiliation: School of Pharmacy, University College Cork, Cork, Ireland.
authors.forename: Stephen
authors.initials: S
authors.lastname: Byrne
authors.affiliation: Division of Geriatrics, Department of Medicine, University College Cork, Cork, Ireland.|Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland.
authors.forename: Denis
authors.initials: D
authors.lastname: O'Mahony
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems / Q000191:economics* / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D016527:Drug Costs / Q000706:statistics & numerical data; D064420:Drug-Related Side Effects and Adverse Reactions / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing / Q000191:economics* / Q000517:prevention & control / Q000706:statistics & numerical data*; D007494:Ireland; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000706:statistics & numerical data*; D008510:Medication Systems, Hospital / Q000191:economics* / Q000706:statistics & numerical data*; D016037:Single-Blind Method
keywords: STOPP/START criteria; adverse drug reaction; elderly; prevention