Validation
Our technology has proven to help clinicians improve patient safety, significantly reduce prescribing costs and prevent hospital admissions.
It is used by clinicians to support comprehensive medication reviews for older patients, in particular, polypharmacy patients with multiple conditions.
Using our technology clinicians have reported:
- A reduction in the number of medications taken by patients which were found to inappropriate
- A significant number of hospital admissions prevented in their highest risk, high cost patient cohort
- Better patient adherence to drug regimens due to better understanding of medications and reduction in unnecessary medications
Patient Example One
| Chronic Conditions | Treatments |
|---|---|
| Diabetes Type 2 | Ramipril 2.5mg OD |
| Heart Failure | Metformin 500mg TID |
| Chronic Kidney Disease | Bisoprolol 10mg OD |
| Hypertension | Aspirin 75mg OD |
| Osteoporosis | Co-Codamol 30/500 BD |
| Chronic Constipation | Gliclazide 40mg daily |
| History of Peptic Ulcer | Vitamin D |
| Tolterodine 1mg BD |
Male Patient: 70 year old
Over five chronic conditions and on multiple medications.
The patient had diabetes from an early age which seemed to be controlled by his metformin tablets and Gliclazide tablets, until recent episodes of hyperglycaemia two of which caused hospitalization. He was recently diagnosed with heart failure and Bisoprolol was initiated.
When the patient was discharged and a full medication review was carried out using StoppStart® software multiple interventions were made by the clinician to the care plan.
| ALERT | ACTION |
|---|---|
| STOPP: Beta-blockers in diabetes mellitus with frequent hypoglycaemic episodes | Bisoprolol stopped. Nebivolol initiated safer in patients >70 years |
| STOPP: Use of regular opioids without concomitant laxative (risk of severe constipation). | Co-codamol stopped. Patient happy to use paracetamol only for mild osteoporosis |
| STOPP: Metformin if CrCl < 30 ml/min (risk of lactic acidosis). | Gliclazide dose increased and glucose levels monitored closely. |
| STOPP: Aspirin with a past history of peptic ulcer disease without concomitant PPI | Started PPI to prevent recurrence of peptic ulcer. |
| STOPP: Antimuscarinic drugs with chronic constipation. | Consider reducing the dose of antimuscarinic and observing frequency of urination. |
| START: Start Statin in diabetes mellitus if co-existing major cardiovascular risk factors present | Discussion with patient was carried out about the benefits of statins especially with diabetes and hypertension. Patient agreed to start statin. |
Patient Example Two
| Chronic Conditions | Treatments |
|---|---|
| Alzheimer’s | Donepizil 10MG OD |
| Dementia | Procyclidine 5MG TID |
| Parkinsonism | Amitriptyline 75mg OD |
| Depression | Warfarin 5MG |
| Atrial Fibrillation | Aspirin 75MG |
| Chronic Constipation | Olanzapine 15mg OD |
Female Patient: 69 years old
Diagnosed two years previous with alzheimer’s disease
This patient’s carers became concerned with the sharp decline in her cognitive ability and increasing dementia. She had experienced a number of falls in the previous six months. By use of StoppStart® software reviewing tool previous inappropriate prescribing was highlighted to the specialist.
| ALERT | ACTION |
|---|---|
| STOPP: TriCyclic Antidepressants (TCAs) with dementia. NOTE: Abrupt withdrawal of a TCA is not recommended. | Potentially responsible for worsening of dementia. Slow withdrawal of TCA initiated |
| STOPP: TriCyclic Antidepressants (TCAs) with cardiac conduction abnormalities | Potential to worsen Atrial Fibrillation. Slow withdrawal of TCA initiated |
| STOPP: Tricyclic antidepressants with constipation | Slow withdrawal of TCA initiated |
| STOPP: Long-term (i.e. > 1 month) neuroleptics as long-term hypnotics. | Olanzapine started 2 years previous for agitation during hospital stay, intended for short term use only. Never removed although agitation subsided. Contributory to confusion, falls and extra-pyramidal side effects. Withdrawal initiated |
| STOPP: Anticholinergics/antimuscarinics in patients with delirium or dementia (risk of exacerbation of cognitive impairment). | Procyclidine initiated previously to treat extra-pyramidal side effects caused by olanzapine. Removal of olanzapine should reduce side effects, scope to stop procyclidine. |
| STOPP: Aspirin in combination with vitamin K antagonist, direct thrombin inhibitor or factor Xa inhibitors in patients with chronic atrial fibrillation. | Aspirin stopped |