431 Summary professionals and CDSS-assistance into one structured medication review intervention, and was investigated in the OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly (OPERAM) trial. The OPERAM trial (Chapter 3.2) was a cluster randomised controlled multicentre trial investigating the effect of an in-hospital medication review performed jointly by a physician and a pharmacist (i.e. pharmacotherapy team) on drug-related readmissions in older (≥70 years) patients with multimorbidity (≥3 chronic conditions) and polypharmacy (≥5 regular medication use). The primary endpoint of OPERAM was the first drug-related hospital admission within one year after inclusion. Eligible patients were randomised in clusters on the level of the attending physician in four European hospitals (Switzerland, Belgium, the Netherlands, and Ireland). In total, 2,008 older adults (median = 9 drugs) were enrolled in 54 intervention clusters (963 participants) and 56 control clusters (1,045 participants) receiving usual care. In the intervention arm, 86% of participants (n = 789) had inappropriate prescribing, with a mean of 2.75 (SD = 2.24) STOPP/START recommendations for each participant. Notably, 62% (n = 491) of intervention patients had ≥1 STOPP/START recommendation successfully implemented at two months, predominantly discontinuing their medication. In the intervention group, 211 participants (21.9%) experienced a first drugrelated hospital admission compared with 234 (22.4%) in the control group. In the intention-to-treat analysis censored for death as a competing event (n = 375, 18.7%), the hazard ratio for first drug-related hospital admission was 0.95 (95% confidence interval [CI] 0.77–1.17). Although the structured CDSS-assisted medication review designed in Chapter 3.1 reduced inappropriate prescribing, it did not significantly affect drug-related hospital admissions. Evaluation of the in-hospital medication review process In Chapter 4, the process of in-hospital medication review as investigated in the OPERAM trial was evaluated in three studies. First, the frequency of CDSS-generated STOPP/START signals and the subsequent acceptance of these signals by a pharmacotherapy team in a hospital setting were determined in Chapter 4.1. In 99% of OPERAM intervention patients, at least one STOPP/START signal was generated during the pharmacotherapy analysis with a median of 6 (IQR 4–8) signals per patient using a set of 110 STOPP/START algorithms. Overall, the pharmacotherapy team accepted 39% of the 5,080 signals after evaluating clinical applicability to the individual patient. These accepted signals resulted in medication optimisation recommendations to be discussed with the attending physician and the patient. The signal to discontinue a drug without a clinical 6
RkJQdWJsaXNoZXIy MTk4NDMw