title: Clinical relevance of the STOPP/START criteria in hip fracture patients.
abstract: OBJECTIVE
  The aim of this study was to investigate the clinical relevance of potentially inappropriate medications (PIMs), identified by the STOPP criteria, and potential prescribing omissions (PPOs), identified by the START criteria, and to identify predictors for clinically relevant PIMs and PPOs.
  
  
  METHODS
  The STOPP and START criteria were applied on the medication lists of 200 older hip fracture patients, consecutively recruited to a randomized controlled study in 2009. For each identified PIM and/or PPO, the clinical relevance was assessed at the individual level, using medical records from both hospital and primary care as well as data collected in the original study.
  
  
  RESULTS
  A total of 555 PIMs/PPOs were identified in 170 (85%) patients (median age: 85 years, 67% female), 298 (54%) of which, in 141 (71%) patients, were assessed as clinically relevant. A greater proportion of PIMs than PPOs were clinically relevant: 71% (95% CI: 66%; 76%) vs. 32% (27%; 38%). A greater proportion of PPOs than PIMs could not be assessed with available information: 38% (32%; 44%) vs. 22% (17%; 27%). Number of drugs and multidose drug dispensing, but not age, sex, cognition, or nursing home residence, were associated with ≥1 clinically relevant PIMs/PPOs.
  
  
  CONCLUSIONS
  The present study illustrates that one in two PIMs/PPOs identified by the STOPP/START criteria is clearly clinically relevant, PIMs being clinically relevant to a greater extent than PPOs. Based on available information, the clinical relevance could not be determined in a non-negligible proportion of PIMs/PPOs. Number of drugs and multidose drug dispensing were associated with ≥1 clinically relevant PIMs/PPOs.
authors.affiliation: Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Lönnbro
authors.affiliation: Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, SE-413 90, Gothenburg, Sweden. susanna.wallerstedt@pharm.gu.se.|Department of Clinical Pharmacology, Sahlgrenska University Hospital, Gothenburg, Sweden. susanna.wallerstedt@pharm.gu.se.
authors.forename: Susanna M
authors.initials: SM
authors.lastname: Wallerstedt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006620:Hip Fractures / Q000503:physiopathology*; D006801:Humans; D057970:Inappropriate Prescribing; D008297:Male
keywords: Clinical relevance; Pharmacoepidemiology; Prescribing quality; START criteria; STOPP criteria