STOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis

Background: Drug-related problems and potentially inappropriate prescribing impose a huge burden on patients and the health-care system. The most widely used tools for appropriate prescription in older adults in England and in other European countries are the Screening Tool of Older People’s Prescri...

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Autores principales:	Jaheeda Gangannagaripalli, Ian Porter, Antoinette Davey, Ignacio Ricci Cabello, Joanne Greenhalgh, Rob Anderson, Simon Briscoe, Carmel Hughes, Rupert Payne, Emma Cockcroft, Jim Harris, Charlotte Bramwell, Jose M Valderas
Formato:	article
Lenguaje:	EN
Publicado:	NIHR Journals Library 2021
Materias:	medication review medication reconciliation inappropriate medication older adults Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/6a59de15b4214298abfb9f79add528b5
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id	oai:doaj.org-article:6a59de15b4214298abfb9f79add528b5
record_format	dspace
institution	DOAJ
collection	DOAJ
language	EN
topic	medication review medication reconciliation inappropriate medication older adults Public aspects of medicine RA1-1270
spellingShingle	medication review medication reconciliation inappropriate medication older adults Public aspects of medicine RA1-1270 Jaheeda Gangannagaripalli Ian Porter Antoinette Davey Ignacio Ricci Cabello Joanne Greenhalgh Rob Anderson Simon Briscoe Carmel Hughes Rupert Payne Emma Cockcroft Jim Harris Charlotte Bramwell Jose M Valderas STOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis
description	Background: Drug-related problems and potentially inappropriate prescribing impose a huge burden on patients and the health-care system. The most widely used tools for appropriate prescription in older adults in England and in other European countries are the Screening Tool of Older People’s Prescriptions (STOPP)/Screening Tool to Alert to the Right Treatment (START) tools. STOPP/START tools support medicines optimisation for older adults. Objectives: To identify, test and refine the programme theories underlying how interventions based on the STOPP/START tools are intended to work, for whom, in what circumstances and why, as well as the resource use and cost requirements or impacts. Design: A realist synthesis. Setting: Primary care, hospital care and nursing homes. Patients: Patients aged ≥ 65 years. Interventions: Any intervention based on the use of the STOPP/START tools. Review methods: Database and web-searching was carried out to retrieve relevant evidence to identify and test programme theories about how interventions based on the use of the STOPP/START tools work. A project reference group made up of health-care professionals, NHS decision-makers, older people, carers and members of the public was set up. In phase 1 we identified programme theories about STOPP/START interventions on how, for whom, in what contexts and why they are intended to work. We searched the peer-reviewed and grey literature to identify documents relevant to the research questions. We interviewed experts in the field in our reference group to gain input on our list of candidate context–mechanism–outcome configurations, to identify additional context–mechanism–outcome configurations and to identify additional literature and/or relevant concepts. In phase 2 we reviewed and synthesised relevant published and unpublished empirical evidence and tested the programme theories using evidence from a larger set of empirical studies. Results: We developed a single logic model structured around three key mechanisms: (1) personalisation, (2) systematisation and (3) evidence implementation. Personalisation: STOPP/START-based interventions are based on shared decision-making, taking into account patient preferences, experiences and expectations (mechanisms), leading to increased patient awareness, adherence, satisfaction, empowerment and quality of life (outcomes). Systematisation: STOPP/START tools provide a standardised/systematic approach for medication reviews (mechanisms), leading to changes in professional and organisational culture and burden/costs (outcomes). Evidence implementation: delivery of STOPP/START-based interventions is based on the implementation of best evidence (mechanisms), reducing adverse outcomes through appropriate prescribing/deprescribing (outcomes). For theory testing, we identified 40 studies of the impact of STOPP/START-based interventions in hospital settings, nursing homes, primary care and community pharmacies. Most of the interventions used multiple mechanisms. We found support for the impact of the personalisation and evidence implementation mechanisms on selected outcome variables, but similar impact was achieved by interventions not relying on these mechanisms. We also observed that the impact of interventions was linked to the proximity of the selected outcomes to the intervention in the logic model, resulting in a clearer benefit for appropriateness of prescribing, adverse drug events and prescription costs. Limitations: None of the available studies had been explicitly designed for evaluating underlying causal mechanisms, and qualitative information was sparse. Conclusions: No particular configuration of the interventions is associated with a greater likelihood of improved outcomes in given settings. Study registration: This study is registered as PROSPERO CRD42018110795. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 23. See the NIHR Journals Library website for further project information.
format	article
author	Jaheeda Gangannagaripalli Ian Porter Antoinette Davey Ignacio Ricci Cabello Joanne Greenhalgh Rob Anderson Simon Briscoe Carmel Hughes Rupert Payne Emma Cockcroft Jim Harris Charlotte Bramwell Jose M Valderas
author_facet	Jaheeda Gangannagaripalli Ian Porter Antoinette Davey Ignacio Ricci Cabello Joanne Greenhalgh Rob Anderson Simon Briscoe Carmel Hughes Rupert Payne Emma Cockcroft Jim Harris Charlotte Bramwell Jose M Valderas
author_sort	Jaheeda Gangannagaripalli
title	STOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis
title_short	STOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis
title_full	STOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis
title_fullStr	STOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis
title_full_unstemmed	STOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis
title_sort	stopp/start interventions to improve medicines management for people aged 65 years and over: a realist synthesis
publisher	NIHR Journals Library
publishDate	2021
url	https://doaj.org/article/6a59de15b4214298abfb9f79add528b5
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spelling	oai:doaj.org-article:6a59de15b4214298abfb9f79add528b52021-11-29T13:06:57ZSTOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis2050-43492050-435710.3310/hsdr09230https://doaj.org/article/6a59de15b4214298abfb9f79add528b52021-11-01T00:00:00Zhttps://doi.org/10.3310/hsdr09230https://doaj.org/toc/2050-4349https://doaj.org/toc/2050-4357Background: Drug-related problems and potentially inappropriate prescribing impose a huge burden on patients and the health-care system. The most widely used tools for appropriate prescription in older adults in England and in other European countries are the Screening Tool of Older People’s Prescriptions (STOPP)/Screening Tool to Alert to the Right Treatment (START) tools. STOPP/START tools support medicines optimisation for older adults. Objectives: To identify, test and refine the programme theories underlying how interventions based on the STOPP/START tools are intended to work, for whom, in what circumstances and why, as well as the resource use and cost requirements or impacts. Design: A realist synthesis. Setting: Primary care, hospital care and nursing homes. Patients: Patients aged ≥ 65 years. Interventions: Any intervention based on the use of the STOPP/START tools. Review methods: Database and web-searching was carried out to retrieve relevant evidence to identify and test programme theories about how interventions based on the use of the STOPP/START tools work. A project reference group made up of health-care professionals, NHS decision-makers, older people, carers and members of the public was set up. In phase 1 we identified programme theories about STOPP/START interventions on how, for whom, in what contexts and why they are intended to work. We searched the peer-reviewed and grey literature to identify documents relevant to the research questions. We interviewed experts in the field in our reference group to gain input on our list of candidate context–mechanism–outcome configurations, to identify additional context–mechanism–outcome configurations and to identify additional literature and/or relevant concepts. In phase 2 we reviewed and synthesised relevant published and unpublished empirical evidence and tested the programme theories using evidence from a larger set of empirical studies. Results: We developed a single logic model structured around three key mechanisms: (1) personalisation, (2) systematisation and (3) evidence implementation. Personalisation: STOPP/START-based interventions are based on shared decision-making, taking into account patient preferences, experiences and expectations (mechanisms), leading to increased patient awareness, adherence, satisfaction, empowerment and quality of life (outcomes). Systematisation: STOPP/START tools provide a standardised/systematic approach for medication reviews (mechanisms), leading to changes in professional and organisational culture and burden/costs (outcomes). Evidence implementation: delivery of STOPP/START-based interventions is based on the implementation of best evidence (mechanisms), reducing adverse outcomes through appropriate prescribing/deprescribing (outcomes). For theory testing, we identified 40 studies of the impact of STOPP/START-based interventions in hospital settings, nursing homes, primary care and community pharmacies. Most of the interventions used multiple mechanisms. We found support for the impact of the personalisation and evidence implementation mechanisms on selected outcome variables, but similar impact was achieved by interventions not relying on these mechanisms. We also observed that the impact of interventions was linked to the proximity of the selected outcomes to the intervention in the logic model, resulting in a clearer benefit for appropriateness of prescribing, adverse drug events and prescription costs. Limitations: None of the available studies had been explicitly designed for evaluating underlying causal mechanisms, and qualitative information was sparse. Conclusions: No particular configuration of the interventions is associated with a greater likelihood of improved outcomes in given settings. Study registration: This study is registered as PROSPERO CRD42018110795. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 23. See the NIHR Journals Library website for further project information.Jaheeda GangannagaripalliIan PorterAntoinette DaveyIgnacio Ricci CabelloJoanne GreenhalghRob AndersonSimon BriscoeCarmel HughesRupert PayneEmma CockcroftJim HarrisCharlotte BramwellJose M ValderasNIHR Journals Libraryarticlemedication reviewmedication reconciliationinappropriate medicationolder adultsPublic aspects of medicineRA1-1270ENHealth Services and Delivery Research, Vol 9, Iss 23 (2021)

STOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis

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