Bastiaan Sallevelt

61 Evaluation of clarity of the STOPP/START criteria Introduction Clinical practice guidelines (CPGs) are instruments intended to provide guidance to healthcare professionals in patient care. Translation of healthcare knowledge, evidence and experience into clear recommendations for patient care, however, is challenging. Studies in the USA and the Netherlands suggest that about 30–40% of patients do not receive care according to evidence based guidelines. A clear description of the desired behaviour has been associated with better compliance with guideline recommendations [1,2]. Recommendations about safe and effective pharmacotherapy are an important part of CPGs. However, it is often unclear whether recommendations also apply to older people.[3-5] A complicating factor is that older people experience more concomitant morbidities, while CPGs often focus on best treatment for a single disease. Ambiguity among prescribers about pharmacotherapy in older people results in inappropriate prescribing, which causes adverse drug reactions, drugrelated hospitalizations, decreased quality of life and even death [6,7]. Due to the lack of clear statements in CPGs about (in)appropriate prescribing in older people with multimorbidity, several explicit screening tools have been developed [8,9]. The most widely used are the Beers criteria [10] and the Screening Tool of Older Persons’ potentially inappropriate Prescriptions/Screening Tool to Alert to Right Treatment (STOPP/START) criteria [11]. CPG recommendations are rarely specified in precise behavioural terms such as what, how, when, and why to stop or start a drug, while explicit screening tools are designed to make clear statements and therefore ease clinical implementation [2]. However, studies continue to report a high prevalence of inappropriate prescribing in older people [12-14]. This suggests implementation can still be improved. Although STOPP/START criteria have shown good inter-rater reliability in studies involving physicians and (hospital)pharmacists working in geriatric units, data on how physicians less familiar with medication optimization would interpret STOPP/START criteria are lacking [15,16]. The question then arises whether the recommended actions are formulated clearly enough to guide prescribers less experienced in geriatric patient care. The aim of this study was to evaluate the clinical applicability of STOPP/START criteria in daily patient care by assessing the clarity of singular criteria with the purpose of improving future clinical guideline recommendations for appropriate prescribing in older people. 2