352 CHAPTER 4.3 an in-hospital medication review. Although pharmacotherapy optimisation reduced potentially inappropriate prescribing, the intervention did not significantly affect the primary outcome DRA nor was it detrimental to patient outcomes compared to usual care [38]. The presumed effect of reducing overuse, underuse, and misuse with an in-hospital structured medication review on preventing DRAs in older people with multimorbidity and polypharmacy was not confirmed. A better understanding of the relationship between the occurrence of potentially preventable DRAs and the detectability of MEs linked to these DRAs during a single, in-hospital medication review may provide guidance on ways to improve the medication review process. The aim of the present study was to assess the detectability of MEs with a STOPP/ START-based in-hospital medication review in older people with polypharmacy and multimorbidity prior to a potentially preventable DRA. Methods Setting, design and study population This study was embedded within the OPERAM trial [37,38]. OPERAM was a large (n = 2008) cluster-randomised controlled trial intended to investigate the effect of a structured medication review on the occurrence of DRAs in older people with multimorbidity and polypharmacy. In-hospital patients were recruited from four hospitals in Switzerland, Belgium, Ireland, and the Netherlands. Inclusion criteria were older age (≥70 years), multimorbidity (defined as ≥3 chronic conditions), and polypharmacy (defined as the use of ≥5 regular medications for more than 30 days prior to admission) [37,38]. The two exclusion criteria were (1) patients admitted to palliative care within 24 hours after index hospitalisation and (2) patients undergoing a structured medication review other than the trial intervention or having received a medication review in the 2 months preceding the index hospitalisation to reduce the risk of contamination bias. Patients included in the OPERAM trial were randomised at index hospitalisation to receive usual pharmaceutical care (control group, n = 1045) or a structured inhospital medication review (intervention group, n = 963). Readmissions occurring after discharge from the index hospitalisation were adjudicated for drug-relatedness consecutively until a first DRA was confirmed or until the one year follow up period ended [37,38]. This substudy relies on data available from the in-hospital medication review in OPERAM intervention patients with a first potentially preventable DRA. The OPERAM trial was approved by the participating hospitals’ medical ethics committees and registered under trial registration number NCT02986425.
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