329 Hospital physicians’ and older patients’ agreement with individualised STOPP/START recommendations both the attending physician and the patient consented; 5) an overview of the recommendations (both implemented during hospital admission and postponed) was transferred to the patient’s general practitioner as a written advice report. The GP was asked to review the postponed recommendations for implementation after hospital discharge in collaboration with the patient. All consecutive steps and the focus of this study (step 4) are summarised in Figure 1. Ethics approval The local ethics committee at each participating trial site approved the OPERAM study protocol, registered under Trial Registration Number NCT02986425. No additional ethical approval was needed for this study, as the data collected and analysed were part of the main trial [20]. Primary outcome The primary outcome of this studywas defined as the STOPP/START recommendations provided by the PT that were agreed upon by both patient and attending hospital physician after discussion with the PT, as illustrated in Figure 1 (step 4). Secondary outcome Reasons for disagreement with the STOPP/START recommendations by the patient and/or attending hospital physician were collected and analysed. Determinants Potential determinants of agreement with the recommendations were investigated. Potential determinants with continuous values were dichotomised or categorised into tertiles based on patient distribution (age, comorbidities, number of medications) or based on clinically accepted cut-off values for measurements (renal function). STOPP/START criteria-related variables were: type of recommendation (STOPP versus START), medication involved (i.e. drug class) and number of recommendations per patient. Patient-related variables include: sex, age group (70-79 years, 80-89 years, ≥90 years), number of comorbidities (<7, 7-9 or ≥9), renal function (eGFR <30, 30-50 or ≥50 ml/min/1.73m2), occurrence of falls in the past year (defined categorically as 0 or ≥1), and number of long term daily medications at inclusion (<9, 9-12 or ≥12). Setting-related variables were: ward type (medical or surgical) and hospital length of stay (<7, 7-14, >14 days). 4
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