366 CHAPTER 4.3 Uitvlugt et al. investigated the prevalence, preventability, and type of MEs in adults (≥18 years) readmitted to a Dutch non-academic hospital [44]. One in six readmissions (16%, N = 1,111) were drug-related of which 40% were considered potentially preventable. Although the study population significantly differed from the OPERAM population (e.g. adult patients vs patients ≥70 years in OPERAM), the proportion of DRAs that were considered potentially preventable was similar (OPERAM intervention patients: 39.8%, n = 84/211; OPERAM control patients, 42.7%, n = 100/234) [38,44]. In both studies, underuse was the most frequently reported ME type, and cardiovascular events and diuretics were most frequently associated with MEs. Based on the results of the current study’s sub-analysis of OPERAM intervention patients, three strategies were identified that may improve DRA prevention in older people with multimorbidity and polypharmacy. Timing of medication review The finding that about half of MEs were not present during the in-hospital medication review provides evidence that the detection of MEs is highly time dependent. Multimorbid older people with polypharmacy are susceptible to changes in (the severity of) medical conditions and pharmacotherapy over time [45]. The effect of a single medication review over a one-year period is therefore difficult to measure. A longitudinal approach to medication review is likely to be more effective than a single, cross-sectional intervention. This theory is supported by the finding that there was no difference between MEs present and not present during in-hospital medication review and the occurrence of potentially preventable DRAs over time (Figure 4). One third of all potentially preventable DRAs occurred within the 2 months after hospital discharge. The cumulative incidence of newly developed MEs was also highest during this period. Previous studies have confirmed that medication errors frequently occur in transition from hospital to primary care, often due to unintentional medication discrepancies [46,47]. Performing a medication review shortly after hospital discharge could therefore have a high impact on reducing MEs [11,12,26]. In about half (n = 11/24) of present MEs, the pharmacotherapy teams decided that a medication change based on STOPP/START criteria was not applicable at the moment of the in-hospital medication review. Explicit screening tools, such as STOPP/START, provide population-based criteria to assist with medication review in older people. However, additional clinical consideration by health care professionals is necessary. A previous sub-analysis of OPERAM intervention patients found that about 40% of CDSS generated STOPP/START signals are of clinical relevance in a hospital setting according to the pharmacotherapy teams [48,49]. Although
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