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
StoppStart Beers Criteria The Worlds First Decision Support Tool for Highlighting Drug to Disease Interactions
StoppStart Beers Criteria The Worlds First Decision Support Tool for Highlighting Drug to Disease Interactions

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