Valoración de la idoneidad de los criterios STOPP/START en el ámbito de atención primaria en España por el método RAND / Assessment of the appropriateness of STOPP/START criteria in primary health care in Spain by the RAND method

Introducción. Pretendemos valorar la idoneidad de los criterios STOPP/START para su utilización en el ámbito de atención primaria (AP) en España. Material y método. Estudio observacional transversal con metodología RAND a 2 rondas realizado en la Gerencia de AP de Vigo con 582.968 habitantes (24% ≥>= 65 años). El grupo de expertos fue constituido por la comisión de farmacia del área, con 12 miembros de diversas especialidades. En una primera ronda, se proporciona a la comisión bibliografía relevante y un cuestionario con los criterios STOPP/START para puntuar la idoneidad en AP con una escala Likert del 1-9 (mínimo, máximo). Cada criterio se clasifica en función de la mediana de las puntuaciones obtenidas y su grado de acuerdo. En una segunda ronda, los expertos debaten los criterios dudosos y las sugerencias aportadas. Resultados. La mayoría de los criterios se consideran apropiados, proponiendo una nueva versión AP2012 con las siguientes diferencias: eliminar START E2 «Bifosfonatos en pacientes que reciben corticoesteroides orales a dosis de mantenimiento»; eliminar START F3 «Antiagregantes plaquetarios en la diabetes mellitus si coexisten uno o más factores mayores de riesgo cardiovascular»; modificar STOPP A9, A15, A16, A17 y E5 y START A1 y A2, por referirse solo a la warfarina y se añade acenocumarol, habitual en nuestro medio, e introducir STOPP C6 «Uso de inhibidores de la bomba de protones (IBP) fuera de sus indicaciones autorizadas». Conclusiones. Los criterios STOPP/START son adecuados para su uso en el ámbito de AP pero es necesaria su adaptación y actualización periódica (AU)

Introduction: A new screenings tool called STOPP/START has been formulated to identify potentially inappropriate prescribing in older people. This study aimed to assess the appropriateness of STOPP/START criteria in primary health care (PHC) in Spain. Material and method: The RAND Appropriateness Method was used to obtain agreement on STOPP/START criteria with two rounds in Vigo PHC with 582.968 inhabitants (24% >=65 years). The pharmacotherapy committee of Vigo PHC area was identified as expert panel, with 12 members from different specialties. In the first round, the committee was provided with relevant literature and a questionnaire with STOPP/START criteria to rate their applicability in PHC with a 9-point Likert scale. Then, each of the criteria was classified according to the median scores and the degree of agreement. In the second round, the experts discussed the undecided criteria and suggestions. Results: Most of the criteria were appropriate. We present a new version with the following differences: to remove START E2 «Biphosphonates in patients taking maintenance oral corticosteroid therapy»; to remove START F3 «Antiplatelet therapy in diabetes mellitus with coexisting major cardiovascular risk factors»; to modify STOPP A9, A15, A16, A17 and E5; and START A1 and A2, adding acenocoumarol to all of them because acenocoumarol is the most used anticoagulant in our country and they only refer to warfarin, and to introduce STOPP C6: «Use of proton pump inhibitors without authorized indication». Conclusions: Criteria STOPP/START are suitable for use PHC but it is necessary to adapt and update them periodically (AU)

[Assessment of the appropriateness of STOPP/START criteria in primary health care in Spain by the RAND method]. / Valoración de la idoneidad de los criterios STOPP/START en el ámbito de atención primaria en España por el método RAND.

INTRODUCTION: A new screenings tool called STOPP/START has been formulated to identify potentially inappropriate prescribing in older people. This study aimed to assess the appropriateness of STOPP/START criteria in primary health care (PHC) in Spain. MATERIAL AND METHOD: The RAND Appropriateness Method was used to obtain agreement on STOPP/START criteria with two rounds in Vigo PHC with 582.968 inhabitants (24% ≥ 65 years). The pharmacotherapy committee of Vigo PHC area was identified as expert panel, with 12 members from different specialties. In the first round, the committee was provided with relevant literature and a questionnaire with STOPP/START criteria to rate their applicability in PHC with a 9-point Likert scale. Then, each of the criteria was classified according to the median scores and the degree of agreement. In the second round, the experts discussed the undecided criteria and suggestions. RESULTS: Most of the criteria were appropriate. We present a new version with the following differences: to remove START E2 «Biphosphonates in patients taking maintenance oral corticosteroid therapy¼; to remove START F3 «Antiplatelet therapy in diabetes mellitus with coexisting major cardiovascular risk factors¼; to modify STOPP A9, A15, A16, A17 and E5; and START A1 and A2, adding acenocoumarol to all of them because acenocoumarol is the most used anticoagulant in our country and they only refer to warfarin, and to introduce STOPP C6: «Use of proton pump inhibitors without authorized indication¼. CONCLUSIONS: Criteria STOPP/START are suitable for use PHC but it is necessary to adapt and update them periodically.