Prevention of Hospital-Acquired Adverse Drug Reactions in Older People Using Screening Tool of Older Persons' Prescriptions and Screening Tool to Alert to Right Treatment Criteria: A Cluster Randomized Controlled Trial

Objectives: To determine whether use of the Screening Tool of Older Persons' Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) criteria reduces incident hospital-acquired adverse drug reactions (ADRs), 28-day medication costs, and median length of hospital stay in older adults admitted with acute illness. Design: Single-blind cluster randomized controlled trial (RCT) of unselected older adults hospitalized over a 13-month period. Setting: Tertiary referral hospital in southern Ireland. Participants: Consecutively admitted individuals aged 65 and older (N = 732). Intervention: Single time point presentation to attending physicians of potentially inappropriate medications according to the STOPP/START criteria. Measurements: The primary outcome was the proportion of participants experiencing one or more ADRs during the index hospitalization. Secondary outcomes were median length of stay (LOS) and 28-day total medication cost. Results: One or more ADRs occurred in 78 of the 372 control participants (21.0%; median age 78, interquartile range (IQR) 72–84) and in 42 of the 360 intervention participants (11.7%; median age 80, IQR 73–85) (absolute risk reduction = 9.3%, number needed to treat = 11). The median LOS in the hospital was 8 days (IQR 4–14 days) in both groups. At discharge, median medication cost was significantly lower in the intervention group (€73.16, IQR €38.68–121.72) than in the control group (€90.62, IQR €49.38–162.53) (Wilcoxon rank test Z statistic = −3.274, P <.001). Conclusion: Application of STOPP/START criteria resulted in significant reductions in ADR incidence and medication costs in acutely ill older adults but did not affect median LOS.