Abstract:
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.
