353 Detectability of medication errors in older people prior to potentially preventable admissions In-hospital medication review The in-hospital structured medication review was assisted by a CDSS with integrated STOPP/START criteria (version 2) [35,36]. In addition to the detection of potential drug overuse, underuse, and misuse based on STOPP/START algorithms, the CDSS generated signals for potential ADRs, clinically relevant drug-drug interactions, and dose adjustments based on a patient’s renal function [39]. A detailed description of the CDSS used in the OPERAM trial and its interface can be found in the Supplementary Information SI1. A pharmacotherapy team consisting of a trained physician and a trained pharmacist for each trial site performed the in-hospital medication review according to the Systematic Tool to Reduce Inappropriate Prescribing (STRIP) method [40]. The pharmacotherapy teams had full access to the patient’s medical record and evaluated all CDSS-generated signals for clinical applicability based on the patient’s actual medical status. Pharmacotherapy optimisation recommendations were presented in a patient-specific feedback report, and the pharmacotherapy teams discussed the report contents with the attending physician and the patient. A second report of in-hospital medication changes and deferred recommendations (e.g. tapering off the use of benzodiazepines) was sent to the GP after discharge. A detailed description of the OPERAM intervention has been previously published [39]. DRA adjudication process All OPERAM patients received follow-up calls at 2, 6, and 12 months after enrolment. The patients or their proxies were asked to report any hospital readmissions since discharge from the index hospitalisation [37]. In case of a hospital readmission, all relevant medical information (e.g. admission and discharge letters, laboratory values, recent medication lists) were obtained from the hospital of readmission and anonymised prior to the DRA adjudication process. Data on readmissions and outcomes of the DRA adjudication process were recorded in an electronic case report form (eCRF). Within the OPERAM trial, all hospital readmissions were screened for potential ADEs through a standardised adjudication process, previously published by Thevelin et al. [14], to establish the primary endpoint (DRA). The DRA adjudication guide can be found in Supplementary Information SI2. DRA adjudication was performed by blinded adjudication teams consisting of senior physician-pharmacist pairs per trial site. DRAs related to MEs (i.e., overuse, underuse, or misuse of drugs) were considered potentially preventable as opposed to DRAs caused by nonpreventable ADRs. The DRA adjudication process allowed for identifying multiple MEs per patient. Overuse was defined as the use of a prescribed drug without a 4
RkJQdWJsaXNoZXIy MTk4NDMw