'Modified STOPP-START criteria for Sri Lanka'; translating to a resource limited healthcare setting by Delphi consensus

Background

‘Screening tool of older people’s prescriptions (STOPP) and screening tool to alert to right treatment (START)’ criteria is a useful tool to assess the appropriateness of medicines among older adults. However, the original STOPP/START criteria developed in the West, may not be directly applicable to resource limited healthcare settings like Sri Lanka. Hence, we aimed to modify STOPP/START criteria (Version 2) to suit Sri Lanka.

Method

Two investigators (a clinical pharmacologist and a pharmacist) reviewed and flagged criteria that were unfeasible to Sri Lanka based on their previous research experiences on using STOPP/START version 1. A Delphi consensus methodology was conducted among six experts, including geriatricians, clinical pharmacologists, physicians and a pharmacist, to review and assess each criterion (including the ones flagged by the researchers) for suitability to Sri Lanka.

Results

Two Delphi validation rounds were conducted. A final meeting was held with the participation of all experts to resolve disagreements and to establish 100% consensus. The expert panel agreed on a list of 105 criteria, including 70 STOPP and 35 START criteria, indicating an 8% reduction in criteria compared to the original version. Modifications included complete removal (n = 11), re-wording (n = 25), splitting (n = 1) of original criteria and adding a new criterion (n = 1). Main reasons for modifications were unavailability of some medicines in the country, unavailability or inaccessibility of specific clinical information required for assessment of criteria, and adherence to treatment guidelines commonly used in the country.

Conclusion

A list of ‘Modified STOPP/START criteria for Sri Lanka’ was developed. These criteria are currently being validated through a multi-centre study.

Quality of Medicine Information in Product Information Leaflets: A Retrospective Audit

BACKGROUND

Nonstandard product information leaflets (PIs) may lead to medication errors. We assessed the completeness, and compatibility of, essential information against reference sources in selected PIs of medicines used in Sri Lanka.

METHODS

Hundred PIs each were used to assess completeness and compatibility of information, respectively. Availability of essential information was checked against drug regulations of the country. Clinical facts were matched against the British National Formulary and/or Australian Medicines Handbook for compatibility. PIs were categorized as "compatible" if all facts stated under each clinical information type were mentioned in at least one of the references; "partially compatible" if only some facts mentioned under each clinical information type were available in at least one of the references; and "totally incompatible" if none of the facts stated in each clinical information type were mentioned in both references.

RESULTS

Of the 100 PIs, 28% did not include at least one of the essential information required by the regulations. Pharmacokinetic data, duration of treatment, overdose, and special dosage information were frequently missing. Nine types of clinical information in PIs matched with reference sources resulted in 900 cross-matches. Among the cross-matches, 80 (8.9%) partial compatibilities and 8 (0.9%) total incompatibilities were encountered. Nearly half (48%) of the PIs had at least one incompatibility.

CONCLUSION

Some PIs lacked important medicines information and were incompatible with known references. PIs need to be carefully prepared by medicine manufacturers and meticulously reviewed by regulatory authorities for accuracy and completeness.