207 OPERAM: intervention protocol 6. Dosage: the final step consists of dose adjustment recommendations based on the Dutch KNMP Kennisbank® database and the patient’s calculated eGFR. When a recommendation is acted upon, the software user can choose to maintain, stop or adjust the concerned medication and/or take other actions including adjustment of other medications in the list or starting a newmedication. After completing the steps above, the analysis is finalized. All choices made are then saved within the STRIPA system and tracked in the background. However, the different steps of the analysis can be revisited at all times, if necessary. When the analysis is considered complete, an overview of all the adaptations to the medication list can be viewed in the ‘advice tab’. Here, all suggested medications to be discontinued are shown in red, newly started medications are in green and manually adjusted medications appear in italics. The medications are still linked to the corresponding medical condition and will appear correspondingly on the report. In the advice tab, the user can manually adapt the plain text of both medical conditions and medications to enhance the final report presented to the patient’s prescribing (internal) physician (see Figure 4a. The internal physician report: (A) final screen in the STRIPA process, and (B) completed report). This will not affect the underlying ATC and ICD10- codes saved in the STRIPA track. Furthermore, comments on the recommendations (other than explanations of STOPP and START criteria which will appear on the report regardless) can be added by the user according to each proposed medication change in order to convince the prescribing physician to follow the advice or to emphasize the importance of the recommendation. Moreover, recommendations can be deferred to the patient’s primary care physician when they are not deemed appropriate to the current acute clinical situation. Lastly, a general comment box exists where the software users can enter extra information or considerations regarding the recommendation or general points of attention relevant to this patient. After all adaptations are made, the report known as the ‘internal physician report’ (see Figure 4b. The internal physician report: (A) final screen in the STRIPA process, and (B) completed report) can be downloaded and printed for discussion with the prescribing hospital physician. 3
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