201 OPERAM: intervention protocol Table 1. Questions in the modified SHiM used in the OPERAM trial. Questions on individual drug level 1. Are you using this drug as prescribed? (dosage, dose frequency and dosage form) 2. If not, what is the reason for deviating (from dosage, frequency or form) or not taking the drug at all? 3. Are you experiencing any side-effects from taking this drug? Questions on a general level 4. Are you using any other prescription drugs that are not mentioned on this list? 5. Are you using non-prescription drugs? 6. Are you using homeopathic drugs or herbal medicines? 7. Are you using drugs that belong to family members or friends? 8. Are you using any ‘as needed’ drugs? 9. Are you using drugs that are no longer prescribed? 10. Do you have any drug allergies? 11. Do you have any drug intolerances? • Step2.Clinical DecisionSupport Systemwith integratedSTOPP/START (STRIPA) The pharmaceutical analysis within the OPERAM trial is carried out by a trained research physician and a trained research pharmacist in mutually supportive roles assisted by the STRIPA software. STOPP/START criteria (version 2) were converted into clinical rules though an extensive, multi-disciplinary process, and these rules were then incorporated into the stand-alone CDSS to assist clinicians in detection of PIP and PPOs. However, suggestions can also be manually entered based on expert opinion by the trained research physician or pharmacist. Within STRIPA, the patient demographic data are entered anonymously, and baseline data including details of age, gender and race are recorded. Race is entered as either black or non-black for the sole purpose of calculating the estimated Glomerular Filtration Rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) formula [35, 36]. The patient clinical data are then entered as medical conditions using the International Statistical Classification of Disease and related Health Problems, 10th revision (ICD-10) codes, current medications as Anatomical Therapeutic Chemical (ATC; level 5) codes and measurements such as blood pressure, bone mineral density and laboratory values using Logical Observation Identifiers Names and Codes (LOINC) codes. The different steps taken during data entry and analysis will now be described in greater detail. 3
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