HPE HPE 90 – November 2018 | Page 22

table 2 Examples of STOPP/START criteria as defined by STOPP START toolkit 42 System STOPP START Gastrointestinal Prochlorperazine and metoclopramide with Parkinson’s. Step down proton pump inhibitors (PPIs) at treatment for >eight weeks PPI in severe GORD or stricture requiring dilation Cardiovascular Furosemide as first-line monotherapy for hypertension Statin therapy with a documented history of coronary, cerebral or peripheral vascular disease and life expectancy >five years Respiratory First generation antihistamines – if patient has fallen in last three months Regular inhaler beta 2 agonist or anticholinergic agent for mild to moderate asthma or COPD table 3 Summary of interventions noted for deprescribing Paper Population Key interventions Findings Follow up Garfinkel and Mangin 16 Elderly patients referred for geriatric assessment Discontinued 311 medicines in 64 patients (average 58% of drugs/ patient) 2% medicines restarted Mean follow up at 19 months Garfinkel et al 17 Disabled geriatric patients resident in a nursing home Discontinued 332 medicines in 119 patients Drug discontinuation failure occurred in 10% all drugs 24% reduction in mortality Approximately 20% reduction in need for referral to acute care One-year follow up to assess mortality McKean et al 18 Patients aged >65 years admitted to general wards with eight or more medicines Discontinued 34.3% of medicines 1.2% medicines were restarted Follow up at median of 78 days Martin and Tannenbaum 19 Patients aged >65 years with polypharmacy and on at least one benzodiazepine Provided patients with EMPOWER brochure – deprescribing tool Complete discontinuation of benzodiazepines achieved in 32% of patients with mild cognitive impairment and 38% of patients with no impairment Three-month follow up Tinetti et al 21 Patients aged >70 years with at least one risk factor from a defined criteria Either or combination of: medicines optimisation, behavioural instructions, exercise programmes or social visits 12% reduction in falls Reduction in risk factors Follow up at one year Campbell et al 23 Patients aged 65 years and on psychotropic medication Gradual withdrawal of psychotropic medicines. A home-based exercise programme Reduction in risk of falls 44 weeks Kutner et al 25 Adults with life expectancy of one month–one year; statin therapy for at least three months Statin therapy stopped Improved quality of life No significant difference in mortality Monthly for up to one year Avraham and Biglow 35 Average age 65.6 years Weaning down of PPIs 90% patients achieved cessation 12 weeks 22 | Issue 90 | 2018 | hospitalpharmacyeurope.com