Applicability of STOPP/START prescribing criteria in integrated Swedish administrative health registries and a Swedish population-based cohort

• Published in: European geriatric medicine 2024, Vol.15 (4), p.1149-1158
• Main Authors: Amrouch, Cheima, Amrouch, Souad, Dai, Lu, Calderón-Larrañaga, Amaia, Wastesson, Jonas W., Johnell, Kristina, Vetrano, Davide Liborio, De Smedt, Delphine, Petrovic, Mirko
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Applicability of STOPP/START; Automation of STOPP/START; Cohort Studies; Female; Geriatrics/Gerontology; Humans; Inappropriate Prescribing - statistics & numerical data; Internal Medicine; Male; Medication review; Medicine; Medicine & Public Health; Potentially Inappropriate Medication List; Registries; Research Paper; Screening tool; STOPP/START; Sweden
• ISSN: 1878-7649; 1878-7657; 1878-7657
• DOI: 10.1007/s41999-024-00990-3

Key summary points Aim This study aimed to assess the applicability of the three available STOPP/START versions in two distinct observational data sources: (i) administrative health registries (ii) population-based cohort study on ageing and care. Findings The first STOPP/START version demonstrated the highest applicability. The population-based cohort study, with its comprehensive clinical assessments, allowed for an enhanced applicability for all three STOPP/START versions. Message To improve the STOPP/START screening tool in research and facilitate result generalisability and comparability, future versions of the screening tool should strive to provide clear and unambiguous disease and drug definitions, as well as comprehensive indications for the operationalisation of the implicit criteria. Purpose The STOPP/START criteria are frequently applied in observational studies to assess potentially inappropriate prescribing in older adults. This study aimed to assess the applicability of the three available STOPP/START versions in two distinct data sources. Methods To evaluate the applicability of the three versions of STOPP/START criteria, we used two observational data sources: (i) Integrated Swedish administrative health registries (ISHR) encompassing routinely collected health data and (ii) the population-based Swedish National study on Aging and Care in Kungsholmen (SNAC-K), based on health professional-led clinical assessments. The Anatomical Therapeutic Classification code (ATC) was used to categorise medications. Diseases were categorised using the international classification of diseases version 10 (ICD10). Results The first STOPP/START version demonstrated an applicability rate of 80% in ISHR and 84% in SNAC-K. The second version demonstrated an applicability of 64% in ISHR and 74% in SNAC-K. The third version showed an applicability of 66% in ISHR and 77% in SNAC-K. Challenges in applicability included broad definitions, vague terminology, and the lack of information on disease severity, symptomatic traits, and stability of certain conditions. Conclusion The applicability of the STOPP/START criteria in observational studies seems to have decreased in more recent versions of the tool. Population-based studies with comprehensive clinical assessments may offer higher applicability compared to studies based on administrative data. Future versions of the STOPP/START criteria should prioritise clear and unambiguous definitions to improve their applicabil