Dalleur O, Boland B, Losseau C, et al. Reduction of potentially inappropriate medications using the STOPP Criteria in frail older inpatients: a randomised controlled study. Drugs & Aging 2014;31(4):291-98
PubMed link: https://www.ncbi.nlm.nih.gov/pubmed/24566877
Full text article: https://link.springer.com/article/10.1007%2Fs40266-014-0157-5
| Methods | Study design: Single-blind randomized controlled study with parallel-design
Number of groups: Two groups |
| Participants | Number of participants: 158 randomized, 50 completed
· Intervention group: 77 randomized, 26 completed · Control group: 81 randomized, 24 completed Age: median 84 years (Interquartile range: 81 to 87 years) Sex: 92 female, 54 male Participants with dementia: Unclear – 26 participants are described as having a “cognitive disorder”. Inclusion criteria: · 75 years of age or older · Risk of frailty defined by an Identification of Seniors At Risk score of at least 2/6 (one point for each of the following: needing help with activities of daily-life; an increase in this need related to the current illness; memory problems; significantly altered vision; hospitalization in the previous 6 months; and daily use of three or more medications at home) · Admission to a medical ward · Availability of a comprehensive geriatric assessment (confirming the frailty profile of the patient) performed by the in-patient geriatric consultation team Exclusion criteria: · Surgical admissions were not included because the revision of chronic medications by surgeons was not considered to be part of standard care · Patients whose discharge letter contained incomplete medication data were excluded from the analysis Concomitant medicines: median 7 medicines (Interquartile range 5 – 9 medicines) – 120 participants used five or more medicines Country: Belgium Setting: Hospital – geriatric ward |
| Interventions | Medicines: Polypharmacy – using STOPP/START criteria v.1
Withdrawal schedule: Not described Comparator: Usual care Method to identify targets: Patient-specific intervention. Medication review: Recommendation by inpatient geriatric consultation team which is a multidisciplinary team consisting of nurses, geriatricians, a dietician, an occupational therapist, a physiotherapist, a speech therapist, and a psychologist. Recommendation to ward physician Tool to identify deprescribing targets: STOPP criteria |
| Outcomes | Proportion of potentially inappropriate medicines ceased between hospital admission and discharge
Characteristics associated with discontinuation of potentially inappropriate medicines at discharge Proportion of potentially inappropriate medicines that were still discontinued 1 year after discharge Clinical significance of the STOPP-related recommendations |
| Dates | Study dates: Not described
Follow-up duration: One year |
| Funding sources | Federal Public Service Health of the Belgian government as part of a national project on the implementation of clinical pharmacy in hospitals |
| Notes | Authors stated that they collectively: “have no conflicts of interest that are directly relevant to the content of this article.” |
Risk of bias table
| Bias | Authors’ judgment | Support for judgment |
| Random sequence generation (selection bias) | High risk | Randomization done, but method may be open to bias.
“Eligible patients were allocated by the in-patient geriatric consultation team nurse to the control or intervention group by simple randomization using drawing of lots (without matching for age or geriatric profile).” |
| Allocation concealment (selection bias) | Unclear risk | Concealment not described although it is stated to be blinded. |
| Blinding of participants and personnel (performance bias) | Unclear risk | Blinding is stated, but method is not described.
“The attending ward physician (who is responsible for prescriptions during hospitalization and at discharge), the evaluator, and the patients were blinded to group assignment.” |
| Blinding of outcome assessment (detection bias) | Low risk | The outcome assessor was blinded.
“The in-patient geriatric consultation team nurse provided the evaluator with a list of the patients included in the study, which did not specify allocation group. The evaluator gathered data on the primary outcome.” |
| Incomplete outcome data (attrition bias) | High risk | There was a low level of one year follow-up. However, this is likely an intrinsic risk and predictable with the study design. |
| Selective reporting (reporting bias) | High risk | The secondary outcome “characteristics associated with discontinuation of potentially inappropriate medicines at discharge” was stated in the methods section, but not reported in the results section. |
| Other bias | High risk | Potential confounding with the multidisciplinary team (nurses, geriatricians, dietician, occupational therapy, physiotherapist, speech therapist,and psychologist) as well as the pharmacist potentially having contact with patients in both groups, or influenced by contact with other colleagues in the study. |
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