264 CHAPTER 3.2 Table SI1.8. Intracluster correlation for main outcomes. Outcome ICC (95% CI) First drug-related hospital admission 0.0103 (0 to 0.0763) Death 0.0198 (0 to 0.1424) First preventable drug-related hospital admission 0.0170 (0 to 0.1692) The intracluster correlation calculations were made using the analysis of variance estimate of ICC and the associated CI calculated using modified Wald test (ICCbin package V1.1.1). Clusters with less than 2 patients were ignored. Abbreviations: CI, confidence interval; ICC, intra-cluster correlation coefficient SI2 Methods appendix The multi-component intervention used in OPERAM was performed on the individual patient level, in several steps. The intervention protocol has been previously published [4]. The intervention was designed to identify the most relevant drug-related problems and optimize treatment during the index hospitalization and was based on the structured medication review using the systemic tool to reduce inappropriate prescribing (STRIP) method [5]. The STRIP method was developed to support pharmacotherapy optimization in older patients. This method combines the STOPP/START criteria [6] to detect medication overuse and underuse with patient-centered implicit methods, such as the Structured History taking of Medication (SHiM, see form below), therapy adherence, adverse drug reactions and shared decision making on proposed medication changes and includes shared decision-making with the patient [5,7]. Pharmacotherapeutic analysis is based on START/STOPP criteria, START/STOPP criteria version 2, with 114 criteria, reflect more complete and up-to-date sets of potentially inappropriate medications and potential prescribing omissions - explicit criteria - in comparison to version 1 in 2008. In addition, version 2 includes three implicit prescribing criteria (STOPP A1, A2, A3). Newly admitted patients were screened, usually on the day of admission to the inpatient ward. Pre-admission medication was assessed using the SHiM questionnaire [7] with the patients or their proxies. In addition, at least one other information source was consulted (pharmacy, general practitioner) to improve the accuracy of the medication list. Next, a trained research physician and pharmacist jointly performed the medication review using the STRIP method [5]. The pharmaceutical analysis was performed
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