| Title: |
Hospital physicians’ and older patients’ agreement with individualised STOPP/START-based medication optimisation recommendations in a clinical trial setting |
| Authors: |
Huibers, Corlina J. A.; Sallevelt, Bastiaan T. G. M.; op Heij, Jody M. J.; O’Mahony, Danis; Rodondi, Nicolas; Dalleur, Olivia; van Marum, Rob J.; Egberts, Antoine C. G.; Wilting, Ingeborg; Knol, Wilma |
| Contributors: |
UCL - SSS/LDRI - Louvain Drug Research Institute; UCL - (SLuc) Département de pharmacie |
| Source: |
European geriatric medicine, Vol. 13, no. 3, p. 541-552 (2022) |
| Publisher Information: |
Springer International Publishing |
| Publication Year: |
2022 |
| Collection: |
DIAL@USL-B (Université Saint-Louis, Bruxelles) |
| Description: |
OBJECTIVE: To evaluate the agreement of hospital physicians and older patients with individualised STOPP/START-based medication optimisation recommendations from a pharmacotherapy team. METHODS: This study was embedded within a large European, multicentre, cluster randomised controlled trial examining the effect of a structured medication review on drug-related hospital admissions in multimorbid (≥ 3 chronic conditions) older people (≥ 70 years) with polypharmacy (≥ 5 chronic medications), called OPERAM. Data from the Dutch intervention arm of this trial were used for this study. Medication review was performed jointly by a physician and pharmacist (i.e. pharmacotherapy team) supported by a Clinical Decision Support System with integrated STOPP/START criteria. Individualised STOPP/START-based medication optimisation recommendations were discussed with patients and attending hospital physicians. RESULTS: 139 patients were included, mean (SD) age 78.3 (5.1) years, 47% male and median (IQR) number of medications at admission 11 (9-14). In total, 371 recommendations were discussed with patients and physicians, overall agreement was 61.6% for STOPP and 60.7% for START recommendations. Highest agreement was found for initiation of osteoporosis agents and discontinuation of proton pump inhibitors (both 74%). Factors associated with higher agreement in multivariate analysis were: female gender (+ 17.1% [3.7; 30.4]), ≥ 1 falls in the past year (+ 15.0% [1.5; 28.5]) and renal impairment i.e. eGFR 30-50 ml/min/1.73 m2; (+ 18.0% [2.0; 34.0]). The main reason for disagreement (40%) was patients' reluctance to discontinue or initiate medication. CONCLUSION: Better patient and physician education regarding the benefit/risk balance of pharmacotherapy, in addition to more precise and up-to-date medical records to avoid irrelevant recommendations, will likely result in higher adherence with future pharmacotherapy optimisation recommendations. CLINICAL TRIAL REGISTRATION: Trial Registration Number NCT02986425. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
boreal:259510; http://hdl.handle.net/2078.1/259510 |
| DOI: |
10.1007/s41999-022-00633-5 |
| Availability: |
http://hdl.handle.net/2078.1/259510; https://doi.org/10.1007/s41999-022-00633-5 |
| Rights: |
info:eu-repo/semantics/openAccess |
| Accession Number: |
edsbas.E504594E |
| Database: |
BASE |