Specifying ICD9, ICPC and ATC codes for the STOPP/START criteria: a multidisciplinary consensus panel

Area of Science:

• Geriatric Pharmacology
• Clinical Pharmacy
• Health Informatics

Background:

• The Screening Tool of Older People's Prescriptions/Screening Tool to Alert Right Pill (STOPP/START) criteria aim to enhance appropriate prescribing in elderly patients.
• Current STOPP/START criteria lack specificity, leading to variable interpretations and application in clinical practice.
• Standardizing STOPP/START criteria with international codes is crucial for automated data extraction from medical records.

Purpose of the Study:

• To develop precise specifications for the STOPP/START criteria using international disease and medication classification codes.
• To facilitate computerized extraction and analysis of prescribing appropriateness in elderly populations.

Main Methods:

• A three-round Delphi consensus procedure involving a multidisciplinary expert panel.
• Agreement was sought on mapping STOPP/START criteria to International Classification of Diseases (ICD9, ICPC) and Anatomical Therapeutic Chemical (ATC) codes.

Main Results:

• Consensus was achieved for 74% of STOPP and 73% of START criteria after two rounds.
• Full consensus was reached for 61/62 STOPP criteria and 26 START criteria after three rounds, with corresponding codes assigned.
• Challenges included the inability to specify one criterion and the lack of perfect corresponding disease codes for some criteria.

Conclusions:

• Expert consensus was necessary due to differing interpretations of STOPP/START criteria.
• The developed coded specifications are essential for future prognostic validation and impact studies on improving elderly prescribing.
• This work lays the foundation for large-scale, data-driven research on medication safety in older adults.