327 Hospital physicians’ and older patients’ agreement with individualised STOPP/START recommendations Introduction Multimorbidity and polypharmacy remain challenging in the context of rapidly ageing populations globally. Although polypharmacy is often indicated in older patients with multimorbidity, it is also associated with an increased risk of negative health outcomes including adverse drug reactions (ADRs) and drug-related hospital admissions (DRAs) [1–3]. Periodic evaluation of the individual patient’s pharmacotherapy by medication review is important to ensure an optimised balance between therapeutic and preventive benefit and potential harms of treatment [4–6]. Several screening tools, both implicit and explicit, have been developed to assist physicians and pharmacists in performing medication reviews [7]. The STOPP/ START criteria are explicit criteria that are widely used in medication reviews for older people, especially in Europe [8,9]. It can, however, be challenging to translate the general population-based STOPP/START recommendations into specific recommendations for the individual patient. An important element of medication review is alignment of a patient’s pharmacotherapy with individual patient’s preferences [10]. Prior research shows that taking patients’ preferences into account will likely result in higher agreement with recommendations [11–13]. Prescriber implementation of pharmacotherapy optimisation recommendations provided by physicians or pharmacists showed large variation in previous studies [14]. Therefore, it is important to investigate the factors that influence the willingness of patients and their attending physicians to follow pharmacotherapy optimisation recommendations and to understand patients’ and physicians’ reasons for disagreement with the recommendations. This could help to improve the effectiveness of medication reviews, increase appropriate prescribing and ultimately reduce negative health outcomes. The aimof the current study was to evaluate the level of agreement, including reasons for disagreement, of hospital physicians and older patients with polypharmacy and multimorbidity with individualised STOPP/START based medication optimisation recommendations from a pharmacotherapy team. Methods Setting, design and study population This study was embedded within The OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people (OPERAM) clinical trial [15]. In brief, OPERAM was a large European, multicentre, cluster randomised controlled trial examining the effect of a structured medication review on drug-related hospital 4
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