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    START (screening tool to alert doctors to the right treatment)--an evidence-based screening tool to detect prescribing omissions in elderly patients.

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    Authors
    Barry, P J
    Gallagher, P
    Ryan, C
    O'mahony, D
    Affiliation
    Cork University Hospital, Department of Geriatric Medicine, Ireland., pat_barry@eircom.net
    Issue Date
    2012-02-03T15:16:33Z
    MeSH
    Age Factors
    Aged
    Aged, 80 and over
    Atherosclerosis/drug therapy
    Atrial Fibrillation/drug therapy
    Calcium/administration & dosage/economics/therapeutic use
    Dietary Supplements
    Evidence-Based Medicine/*methods
    Guideline Adherence/*statistics & numerical data
    Humans
    Hydroxymethylglutaryl-CoA Reductase Inhibitors/economics/therapeutic use
    Mass Screening/*methods
    Osteoporosis/drug therapy
    Physician's Practice Patterns/*statistics & numerical data
    Platelet Aggregation Inhibitors/economics/therapeutic use
    Prevalence
    Vascular Diseases/drug therapy
    Warfarin/economics/therapeutic use
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    Citation
    Age Ageing. 2007 Nov;36(6):632-8. Epub 2007 Sep 19.
    Journal
    Age and ageing
    URI
    http://hdl.handle.net/10147/209262
    DOI
    10.1093/ageing/afm118
    PubMed ID
    17881418
    Abstract
    BACKGROUND: Inappropriate prescribing encompasses acts of commission i.e. giving drugs that are contraindicated or unsuitable, and acts of omission i.e. failure to prescribe drugs when indicated due to ignorance of evidence base or other irrational basis e.g. ageism. There are considerable published data on the prevalence of inappropriate prescribing; however, there are no recent published data on the prevalence of acts of omission. The aim of this study was to calculate the prevalence of acts of prescribing omission in a population of consecutively hospitalised elderly people. METHODS: A screening tool (screening tool to alert doctors to the right treatment acronym, START), devised from evidence-based prescribing indicators and arranged according to physiological systems was prepared and validated for identifying prescribing omissions in older adults. Data on active medical problems and prescribed medicines were collected in 600 consecutive elderly patients admitted from the community with acute illness to a teaching hospital. On identification of an omitted medication, the patient's medical records were studied to look for a valid reason for the prescribing omission. RESULTS: Using the START list, we found one or more prescribing omissions in 57.9% of patients. In order of prevalence, the most common prescribing omissions were: statins in atherosclerotic disease (26%), warfarin in chronic atrial fibrillation (9.5%), anti-platelet therapy in arterial disease (7.3%) and calcium/vitamin D supplementation in symptomatic osteoporosis (6%). CONCLUSION: Failure to prescribe appropriate medicines is a highly prevalent problem among older people presenting to hospital with acute illness. A validated screening tool (START) is one method of systematically identifying appropriate omitted medicines in clinical practice.
    Language
    eng
    ISSN
    1468-2834 (Electronic)
    0002-0729 (Linking)
    ae974a485f413a2113503eed53cd6c53
    10.1093/ageing/afm118
    Scopus Count
    Collections
    Cork University Hospital

    entitlement

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