Article Text

Potentially inappropriate prescribing (PIP) in long-term care (LTC) patients: validation of the 2014 STOPP-START and 2012 Beers criteria in a LTC population—a protocol for a cross-sectional comparison of clinical and health administrative data
  1. Lise M Bjerre1,2,3,4,
  2. Roland Halil1,5,
  3. Christina Catley4,
  4. Barbara Farrell1,2,6,
  5. Matthew Hogel1,2,
  6. Cody D Black1,2,
  7. Margo Williams2,
  8. Cristín Ryan7,
  9. Douglas G Manuel1,2,3,4,8
  1. 1Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
  2. 2C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
  3. 3School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
  4. 4ICES@ uOttawa, Ottawa, Ontario, Canada
  5. 5Bruyere Academic Family Health Team, Ottawa, Ontario, Canada
  6. 6School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
  7. 7School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
  8. 8Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  1. Correspondence to Dr Lise M Bjerre; lbjerre{at}


Introduction Potentially inappropriate prescribing (PIP) is frequent and problematic in older patients. Identifying PIP is necessary to improve prescribing quality; ideally, this should be performed at the population level. Screening Tool of Older Persons’ potentially inappropriate Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) and Beers criteria were developed to identify PIP in clinical settings and are useful at the individual patient level; however, they are time-consuming and costly to apply. Only a subset of these criteria is applicable to routinely collected population-level health administrative data (HAD) because the clinical information necessary to implement these tools is often missing from databases. The performance of subsets of STOPP/START and Beers criteria in HAD compared with clinical data from the same patients is unknown; furthermore, the performance of the updated 2014 STOPP-START and 2012 Beers criteria compared with one another is also unknown.

Methods and analysis A cross-sectional study of linked HAD and clinical data will be conducted to validate the subsets of STOPP/START and Beers criteria applicable to HAD by comparing their performance when applied to clinical and HAD for the same patients. Eligible patients will be 66 years and over and recently admitted to 1 of 6 long-term care facilities in Ottawa, Ontario. The target sample size is 275, but may be less if statistical significance can be achieved sooner. Medication, diagnostic and clinical data will be collected by a consultant pharmacist. The main outcome measure is the proportion of PIP missed by the subset of STOPP/START and Beers criteria applied to HAD when compared with clinical data.

Ethics and dissemination The study was approved by the Ottawa Health Services Network Research Ethics Board, the Bruyère Continuing Care Research Ethics Board and the ethics board of the City of Ottawa Long Term Care Homes. Dissemination will occur via publication, national and international conference presentations, and exchanges with regional, provincial and national stakeholders.

Trial registration number NCT02523482.


This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Files in this Data Supplement:

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.