279 Frequency and acceptance of CDSS-generated STOPP/START signals Methods Setting, design and study population This study was embedded in the (OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly) trial – a cluster-randomised controlled trial investigating the effect of a structured medication review on drug-related hospital admissions (DRAs). As previously described in detail, in-hospital patients were recruited from four hospitals in four countries (Switzerland, Belgium, Ireland, the Netherlands) and randomised to receive usual pharmaceutical care (control group) or a CDSS-assisted structured medication review (intervention group) [13]. Inclusion criteria were age ≥70 years, multimorbidity (defined as ≥3 chronic conditions), and polypharmacy (defined as the use of ≥5 regular medications for over 30 days prior to admission). There were two exclusion criteria: 1) patients admitted to palliative care within 24 hours after hospital admission and 2) patients undergoing a structured medication review other than the trial intervention or having received a medication review during the two months preceding the index hospitalisation to reduce the risk of contamination bias. Both medical (e.g. internal medicine, cardiology, pulmonology, neurology) and surgical (e.g. general surgery, vascular surgery, orthopaedics, neurosurgery) wards were eligible for inclusion. However, geriatric wards were excluded to comply with the exclusion criteria, because medication optimisation was considered standard of geriatric care in all participating trial sites. The OPERAM trial was approved by the participating hospitals’ medical ethics committees and registered under trial registration number NCT02986425. In this study, OPERAM intervention patients for whom data from the in-hospital CDSS-assisted medication review were available, were included for analysis. The structured medication review was conducted by a team comprising a physician and a pharmacist (hereafter pharmacotherapy team) who were trained by standardised operating procedures in all sites. The medication review was performed according to the Systematic Tool to Reduce Inappropriate Prescribing (STRIP) method [14] and consisted of five consecutive steps [15]: 1) a structured history taking of medication use (SHiM) [16] and data entry of relevant and available patient information into the CDSS (i.e. current in-hospital medication list updated by information from SHiM, medical conditions, laboratory values, signs and patientreported symptoms); 2) digitalised screening of the current medication list for medication over- and underuse by STOPP/START algorithms; 3) a pharmacotherapy analysis by the pharmacotherapy team who evaluated CDSS-generated signals for clinical applicability to each patient based on the patient’s medical status. Accepted signals were translated into patient-specific medication optimisation recommendations and presented on a feedback report in a standardised format; 4
RkJQdWJsaXNoZXIy MTk4NDMw