63 Evaluation of clarity of the STOPP/START criteria of two appraisers, consisting of a geriatric resident (CH) and a hospital pharmacist resident (BS), both experienced with the application of STOPP/START criteria in daily practice. The clarity for each of these three elements was rated from the perspective of a ‘junior’ physician or pharmacist with a basic level of knowledge (≤ 5 years of clinical post-graduate experience). The appraisers were trained with a rating guidance, developed and approved by senior clinicians (TE/EP/IW/WK) prior to rating the elements independently. If ratings differed more than 1 point, a senior hospital pharmacist/clinical pharmacologist (IW) or a senior geriatrician/clinical pharmacologist (WK) was consulted as a third appraiser until consensus was reached. Descriptive components of conditions In addition to the calculation of clarity ratings for the action, condition and explanation, the nature of the conditions was further explored. The condition identifies the target population and is the most heterogeneous element. By stratifying the conditions into descriptive components, the nature of the components in relation to their clarity could be assessed. These components could lead to different strategies to optimize ‘specific and unambiguous’ wording in describing conditions. The conditions were subdivided into five components that were considered essential for identification of the target population: disease, sign, symptom, laboratory finding and medication. Definitions of four components were based on the ontology as described by Scheuermann et al [21]. Signs are defined as bodily features observed in a physical examination including measurements (e.g. blood pressure), while symptoms are bodily features experienced by a patient (e.g. restless legs). Since optimization of polypharmacy is the main focus of the STOPP/START, the target population can also be described by (co-)medication. Medication is not defined by Scheuermann et al. Therefore, medication was added as a fifth component using the definition for medicinal products by the European Medicines Agency (EMA) as ‘a substance or combination of substances that is intended to treat, prevent or diagnose a disease, or to restore, correct or modify physiological functions by exerting a pharmacological, immunological or metabolic action’[22]. Data analysis Clarity ratings for each of the three elements (action, condition, explanation) were calculated as a percentage of the obtained scores given by appraiser 1 and 2 divided by the maximum score. 2
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