209 OPERAM: intervention protocol • Step 3: Communication and discussion of the STRIPA report with the prescribing physician After the first analysis has been conducted and the prescribing physician report is complete, the research pharmacist and research physician contact the prescribing physician and discuss the implementation of the STRIPA-generated recommendations. The objective is to incorporate the prescribing recommendations with the insight that the prescribing physician can provide with regards to the overall functional capacity of the patient to reach a consensus about the recommendations that should be implemented to prevent both ADRs during the hospital stay, and later drug-related readmissions (i.e. the primary endpoint of the OPERAM trial). • Step 4. Shared-decision making with the patient Subsequently, once consensus has been reached between the researchers and the prescribing physician, the process of shared decision-making (SDM) can take place if the prescribing physician has identified preference-sensitive decisions with regard to stopping, starting, continuing or selecting medications for discussion with the patient. SDM has been defined as “an approach where healthcare professionals and patients share the best available evidence when faced with making decisions regarding healthcare, and where patients are supported to consider options to achieve informed preferences” [39]. This process addresses patients’ autonomy and promotes patient engagement [39], and it has repeatedly been shown to play an integral role in a successful de-prescribing of harmful drugs [42–40]. The model for SDM has previously been described elsewhere [43]. Briefly, it is centred around 4 main principles i.e. ‘choice talk’, ‘option talk’, ‘preference talk’ and ‘decision talk’ [43]. All patients, in particular patients with cognitive impairment, should be facilitated to have another relevant person (e.g. close family member) present when making any decisions in the SDM process. Collectively, the research team and the patient agree on definitive medication changes to be made and then proceed to develop a pharmaceutical care plan. Changes after the SDM process are communicated to the prescribing physician, and in some cases, the SDM can be deferred to the patient’s GP; if so, this is documented on the GP information letter, as will be discussed in the next section. • Step 5: Discharge and the GP information report Once recommendations are agreed between the research team, the prescribing physician and the patient, the changes to the patient’s medications are entered into STRIPA and a report known as the “GP report” is generated. Where the prescribing physician has accepted STRIPA recommendations, these recommendations are included in the GP report. Where the prescribing physician has made changes 3
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