STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation.
AffiliationDepartment of Geriatric Medicine, Cork University Hospital, Wilton, Cork,, Ireland.
MeSHAbbreviations as Topic
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
Drug Prescriptions/classification/*statistics & numerical data
Drug Therapy/adverse effects/standards/statistics & numerical data
Drug Utilization Review/*methods/statistics & numerical data
Glomerular Filtration Rate/drug effects
Health Services for the Aged/organization & administration/*statistics &
Physician's Practice Patterns/*statistics & numerical data
Reproducibility of Results
Ticlopidine/analogs & derivatives/therapeutic use
MetadataShow full item record
CitationInt J Clin Pharmacol Ther. 2008 Feb;46(2):72-83.
JournalInternational journal of clinical pharmacology and therapeutics
AbstractOBJECTIVE: Older people experience more concurrent illnesses, are prescribed more medications and suffer more adverse drug events than younger people. Many drugs predispose older people to adverse events such as falls and cognitive impairment, thus increasing morbidity and health resource utilization. At the same time, older people are often denied potentially beneficial, clinically indicated medications without a valid reason. We aimed to validate a new screening tool of older persons' prescriptions incorporating criteria for potentially inappropriate drugs called STOPP (Screening Tool of Older Persons' Prescriptions) and criteria for potentially appropriate, indicated drugs called START (Screening Tool to Alert doctors to Right, i.e. appropriate, indicated Treatment). METHODS: A Delphi consensus technique was used to establish the content validity of STOPP/START. An 18-member expert panel from academic centers in Ireland and the United Kingdom completed two rounds of the Delphi process by mail survey. Inter-rater reliability was assessed by determining the kappa-statistic for measure of agreement on 100 data-sets. RESULTS: STOPP is comprised of 65 clinically significant criteria for potentially inappropriate prescribing in older people. Each criterion is accompanied by a concise explanation as to why the prescribing practice is potentially inappropriate. START consists of 22 evidence-based prescribing indicators for commonly encountered diseases in older people. Inter-rater reliability is favorable with a kappa-coefficient of 0.75 for STOPP and 0.68 for START. CONCLUSION: STOPP/START is a valid, reliable and comprehensive screening tool that enables the prescribing physician to appraise an older patient's prescription drugs in the context of his/her concurrent diagnoses.
- Potentially inappropriate prescribing in an Irish elderly population in primary care.
- Authors: Ryan C, O'Mahony D, Kennedy J, Weedle P, Byrne S
- Issue date: 2009 Dec
- Application of the STOPP/START criteria: a systematic review of the prevalence of potentially inappropriate prescribing in older adults, and evidence of clinical, humanistic and economic impact.
- Authors: Hill-Taylor B, Sketris I, Hayden J, Byrne S, O'Sullivan D, Christie R
- Issue date: 2013 Oct
- STOPP/START criteria for potentially inappropriate prescribing in older people: version 2.
- Authors: O'Mahony D, O'Sullivan D, Byrne S, O'Connor MN, Ryan C, Gallagher P
- Issue date: 2015 Mar
- An inter-rater reliability study of the prescribing indicated medications quality indicators of the Assessing Care Of Vulnerable Elders (ACOVE) 3 criteria as a potentially inappropriate prescribing tool.
- Authors: San-José A, Agustí A, Vidal X, Barbé J, Torres OH, Ramírez-Duque N, García J, Fernández-Moyano A, López-Soto A, Formiga F, Potentially Inappropriate Prescribing in Older Patients in Spain (PIPOPS) Investigators’ project.
- Issue date: 2014 May-Jun
- Evaluation of clarity of the STOPP/START criteria for clinical applicability in prescribing for older people: a quality appraisal study.
- Authors: Sallevelt BTGM, Huibers CJA, Knol W, Puijenbroek EV, Egberts T, Wilting I
- Issue date: 2020 Feb 18