Question 1

What is the difference between STOPP/START and Beers Criteria?

Accepted Answer

STOPP/START includes both potentially inappropriate medications (STOPP) and potential prescribing omissions (START); Beers focuses primarily on inappropriate medications. STOPP/START is organised by physiological system, making it easier to use during system-based medication review. Beers is organised by medication class. Both have similar detection rates for PIMs, but STOPP identifies clinically significant PIMs at a higher rate in some studies.

Question 2

Does implementing STOPP/START improve patient outcomes?

Accepted Answer

Randomised trials of STOPP/START-based medication review have shown significant reductions in medication count, potentially inappropriate medication use, and medication costs. The SENATOR trial did not demonstrate a reduction in adverse drug reactions, suggesting that screening tools alone are insufficient — integration with clinical decision support and pharmacist-led review may be needed.

Question 3

Can STOPP/START be used in patients with limited life expectancy?

Accepted Answer

Yes — the criteria include guidance on deprescribing in patients with limited life expectancy (e.g., stopping statins for primary prevention, stopping bisphosphonates). However, in palliative care, the goals are primarily comfort and symptom control, and some STOPP recommendations (e.g., stopping proton pump inhibitors) may not apply.

Question 4

How long does it take to complete a STOPP/START review?

Accepted Answer

For a patient with 8–12 medications and 5–8 comorbidities, a complete STOPP/START review takes approximately 10–20 minutes for an experienced clinician. Computerised decision support integration can reduce this to 5–10 minutes by automating the screening process.