PhD thesis: a PhD thesis.
STOPP & START criteria to detecting potentially inappropriate prescribing in hospitalized older adults: Application at European level and validation of an adaptation into French-language,
Thèse de Privat Docent
Accessible on Internet: http://www.archive-ouverte.unige.ch/unige:19376
One of the objectives of care during the hospitalization of elderly patients, in addition to the therapeutic management of diseases, is the preservation of patients' autonomy and ability to perform activities of daily living. Once admitted to the hospital, elderly patients are at risk of functional, physical, and mental impairment, which can lead to loss of autonomy and generally results in a burden to the family, the need for professional help, entry into an institutional setting, or even death. Inappropriate prescribing of medications is one of the most important causes of morbidity and mortality within this population and therefore potentially inappropriate prescribing medication (PIM) an issue of major importance in pharmacotherapy of older patients globally. To date, Beers' criteria have been in common research usage for defining potentially inappropriate medications in older people. However, Beers' criteria have been a number of serious flaws and are of doubtful relevance to routine geriatric pharmacotherapy. For these reasons, new geriatric PIMs have been devised and validated, called screening tool for older person's prescriptions (STOPP) and screening tool to alert doctor to right treatment (START) for detection of potentially errors of prescribing commission and omission. Prospective data showed that STOPP & START criteria detected adverse drug effects (ADE) that are causal or contributory to acute hospitalisation suggesting that ADE are likely associated with PIM. With the aim to prevent PIM and ADE, STOPP & START criteria appears as: (i) a new well design evidence-based and (ii) physiological system-based tool that captures common instances of potentially inappropriate prescribing, including prescribing omission; (ii) easy and quick to use in day-to-day practice (< 2 minutes); and (iii) this with a favourable inter-rater reliability between a 18-member experts panel comprising teaching hospital consultants in geriatric medicine, clinical pharmacotherapy and old age psychiatry, senior academic primary care physicians with interest in geriatric pharmacology. Panellists were thus representing of the range of medical specialities that are regularly involved in geriatric pharmacotherapy. Using the original English version, we detailed thereafter five studies that contributed to further validate at European level and to translate into French-language this interesting, comprehensive and reliable screening tool, that enables physician to appraise an older patient's prescription drugs in the context of his/her concurrent diagnoses.
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