283 Frequency and acceptance of CDSS-generated STOPP/START signals Figure 2. Flowchart of the study population. 1Reasons why no in-hospital pharmacotherapy analysis was performed in 88 (9%) of the OPERAM intervention patients were not collected on patient level but included: patient was discharged or transferred from ward, patient died, patient withdrew from study, other reasons. 2 The pharmacotherapy team had to actively save the results into the CDSS. Due to technical failure, results were not saved in the CDSS in 49 (5%) of the OPERAM intervention patients. The distribution of patients among the four participating trial sites was 399 (48.3%), 132 (16.0%), 92 (11.1%) and 203 (24.6%) for Switzerland, Belgium, Ireland, and the Netherlands, respectively. The study population had a median age of 78 (IQR 74– 84); the median number of co-morbidities was 11 (IQR 8–17), and the median number of medications was 10 (IQR 7–13). 8.4% of the study patients were nursing home residents, and the Barthel Index of Activities of Daily Living score [18] was high (median 95; IQR 75–100) (Table 1). Frequency of STOPP/START signals In total, 5,080 STOPP/START signals were generated in 826 patients. The median was 6 (IQR 4–8) generated signals per patient. No signals were generated in 0.8% (n=7) of the patients, whereas 1–3, 4–6 and >6 signals were generated in 39%, 38% and 22% of the patients, respectively. Of the generated signals, 68.2% (n=3,465) were based on STOPP criteria. In 96% (n=791) of patients, ≥1 STOPP signals were generated with a median of 4 (IQR 2–6) per patient, and 31.8% (n=1,615) of the generated signals were based on START criteria. In 82% (n=681) of cases, ≥1 START signals were generated with a median of 2 (IQR 1–3) per patient. The distribution of generated signals per patient was comparable across countries and ranged between 93–98% for ≥1 STOPP signal and 80–87% for ≥1 START signal. 4
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