211 OPERAM: intervention protocol Discussion ADRs, which are particularly likely to occur during acute hospital admission, cause significant morbidity in older patients and contribute to increased healthcare costs [45]. ADRs are common in older multi-morbid patients and often lead to acute hospitalization despite reports that approximately 50% of these drug-related admissions (DRA) are likely to be preventable [7, 46]. Growing evidence indicates that optimising pharmacotherapy, through various interventional designs, mitigates inappropriate prescribing as well as the incidence of ADRs and associated costs in this high-risk patient population [11, 15, 16]. Although there is insufficient data to support the use of a single validated intervention, a recent review highlighted the value of several methods including close liaison between physicians and clinical pharmacists as well as the use of implicit and explicit prescribing criteria such as STOPP/START [11]. A particular strength of the OPERAM trial is its novelty, i.e. it is one of the first computerised interventions designed to incorporate a structured medication review to look at potentially inappropriate prescribing and potential prescribing omissions in older hospitalised patients, and assesses whether it reduces drug-related hospital admissions. It also recognises the importance of the identification of patient-reported clinical signs and symptoms that may be related to PIP. Moreover, it relies on multi-disciplinary input and collaboration between physicians and pharmacists and clear communication of prescribing information with GPs, which will likely increase the impact of prescribing recommendations on patient care. Finally, the SDM process allows for greater emphasis to be placed on a patient-centred approach, encouraging patient engagement with their own healthcare. The integration of multiple interventions that have demonstrated benefit is anticipated to have a synergistic effect on pharmacotherapy quality. The study can also demonstrate the feasibility of a multi-component intervention in a hospital environment. A key strength of the OPERAM trial will be its demonstration of feasibility in differing healthcare environments of the EU and non-EU countries. The OPERAM trial will also analyze the intervention from a health economics perspective and will allow for the determination of the benefit that the intervention can provide to society in general through a reduction in healthcare expenditure. Recruitment for the OPERAM trial began in December 2016 and finished in October 2018. Trial follow-up will be completed in October 2019 and trial results are expected in the first quarter of 2020. 3
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