| Title: |
Optimizing Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older Adults (OPERAM):Cluster randomised controlled trial |
| Authors: |
Blum,Manuel R.; Sallevelt, Bastiaan T.G.M.; Spinewine,Anne; O'Mahony,Denis; Moutzouri,Elisavet; Feller,Martin; Baumgartner,Christine; Roumet,Marie; Jungo,Katharina Tabea; Schwab,Nathalie; Bretagne,Lisa; Beglinger,Shanthi; Aubert,Carole E.; Wilting, Ingeborg; Thevelin,Stefanie; Murphy,Kevin; Huibers, Corlina J.A.; Clara Drenth-Van Maanen, A.; Boland,Benoit; Crowley,Erin; Eichenberger,Anne; Meulendijk,Michiel; Jennings,Emma; Adam,Luise; Roos,Marvin J.; Gleeson,Laura; Shen,Zhengru; Marien,Sophie; Meinders,Arend Jan; Baretella,Oliver; Netzer,Seraina; De Montmollin,Maria; Fournier,Anne; Mouzon,Ariane; O'Mahony,Cian; Aujesky,Drahomir; Mavridis,Dimitris; Byrne,Stephen; Jansen, Paul A.F.; Schwenkglenks,Matthias; Spruit, Marco; Dalleur,Olivia; Knol, Wilma; Trelle,Sven; Rodondi,Nicolas; Apotheek Opleiding; Apotheek; Apotheek Klinische Farmacie; MS Geriatrie; Circulatory Health |
| Publication Year: |
2021 |
| Subject Terms: |
General Medicine; Journal Article; Research Support; Non-U.S. Gov't |
| Description: |
Objective To examine the effect of optimising drug treatment on drug related hospital admissions in older adults with multimorbidity and polypharmacy admitted to hospital. Design Cluster randomised controlled trial. Setting 110 clusters of inpatient wards within university based hospitals in four European countries (Switzerland, Netherlands, Belgium, and Republic of Ireland) defined by attending hospital doctors. Participants 2008 older adults (≥70 years) with multimorbidity (≥3 chronic conditions) and polypharmacy (≥5 drugs used long term). Intervention Clinical staff clusters were randomised to usual care or a structured pharmacotherapy optimisation intervention performed at the individual level jointly by a doctor and a pharmacist, with the support of a clinical decision software system deploying the screening tool of older person's prescriptions and screening tool to alert to the right treatment (STOPP/START) criteria to identify potentially inappropriate prescribing. Main outcome measure Primary outcome was first drug related hospital admission within 12 months. Results 2008 older adults (median nine drugs) were randomised and enrolled in 54 intervention clusters (963 participants) and 56 control clusters (1045 participants) receiving usual care. In the intervention arm, 86.1% of participants (n=789) had inappropriate prescribing, with a mean of 2.75 (SD 2.24) STOPP/START recommendations for each participant. 62.2% (n=491) had ≥1 recommendation successfully implemented at two months, predominantly discontinuation of potentially inappropriate drugs. In the intervention group, 211 participants (21.9%) experienced a first drug related hospital admission compared with 234 (22.4%) in the control group. In the intention-to-treat analysis censored for death as competing event (n=375, 18.7%), the hazard ratio for first drug related hospital admission was 0.95 (95% confidence interval 0.77 to 1.17). In the per protocol analysis, the hazard ratio for a drug related hospital admission was 0.91 (0.69 to 1.19). The ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
text/plain |
| Language: |
English |
| ISSN: |
1756-1833 |
| Relation: |
https://dspace.library.uu.nl/handle/1874/443122 |
| Availability: |
https://dspace.library.uu.nl/handle/1874/443122 |
| Rights: |
info:eu-repo/semantics/OpenAccess |
| Accession Number: |
edsbas.3860CD5 |
| Database: |
BASE |