Rationale and design of OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people (OPERAM): a cluster randomised controlled trial [Protocol].

Adam, Luise; Moutzouri, Elisavet; Baumgartner, Christine; Loewe, Axel Lennart; Feller, Martin; M'Rabet Bensalah, Khadija; Schwab, Nathalie; Hossmann, Stefanie; Schneider, Claudio; Jegerlehner, Sabrina; Floriani, Carmen; Limacher, Andreas; Jungo, Katharina Tabea; Huibers, Corlina Johanna Alida; Streit, Sven; Schwenkglenks, Matthias; Spruit, Marco; van Dorland, Hendrika Anette; Donzé, Jacques; Kearney, Patricia M; ... (2019). Rationale and design of OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people (OPERAM): a cluster randomised controlled trial [Protocol]. BMJ open, 9(6), e026769. BMJ Publishing Group 10.1136/bmjopen-2018-026769

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INTRODUCTION Multimorbidity and polypharmacy are important risk factors for drug-related hospital admissions (DRAs). DRAs are often linked to prescribing problems (overprescribing and underprescribing), as well as non-adherence with drug regimens for different reasons. In this trial, we aim to assess whether a structured medication review compared with standard care can reduce DRAs in multimorbid older patients with polypharmacy. METHODS AND ANALYSIS OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people is a European multicentre, cluster randomised, controlled trial. Hospitalised patients ≥70 years with ≥3 chronic medical conditions and concurrent use of ≥5 chronic medications are included in the four participating study centres of Bern (Switzerland), Utrecht (The Netherlands), Brussels (Belgium) and Cork (Ireland). Patients treated by the same prescribing physician constitute a cluster, and clusters are randomised 1:1 to either standard care or Systematic Tool to Reduce Inappropriate Prescribing (STRIP) intervention with the help of a clinical decision support system, the STRIP Assistant. STRIP is a structured method performing customised medication reviews, based on Screening Tool of Older People's Prescriptions/Screening  Tool to Alert to Right Treatment criteria to detect potentially inappropriate prescribing. The primary endpoint is any DRA where the main reason or a contributory reason for the patient's admission is caused by overtreatment or undertreatment, and/or inappropriate treatment. Secondary endpoints include number of any hospitalisations, all-cause mortality, number of falls, quality of life, degree of polypharmacy, activities of daily living, patient's drug compliance, the number of significant drug-drug interactions, drug overuse and underuse and potentially inappropriate medication. ETHICS AND DISSEMINATION The local Ethics Committees in Switzerland, Ireland, The Netherlands and Belgium approved this trial protocol. We will publish the results of this trial in a peer-reviewed journal. MAIN FUNDING European Union's Horizon 2020 programme. TRIAL REGISTRATION NUMBER NCT02986425 , SNCTP000002183 , NTR6012, U1111-1181-9400.

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine

UniBE Contributor:

Adam, Luise Leonore; Moutzouri, Elisavet; Baumgartner, Christine; Löwe, Axel Lennart; Feller, Martin; M'Rabet Bensalah, Khadija; Schwab, Nathalie Christa; Hossmann, Stefanie; Schneider, Claudio; Jegerlehner, Sabrina; Floriani, Carmen; Limacher, Andreas; Jungo, Katharina Tabea; Streit, Sven; van Dorland, Hendrika Anette; Donzé, Jacques; Aujesky, Drahomir; Trelle, Sven and Rodondi, Nicolas

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

2044-6055

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

13 Jun 2019 08:43

Last Modified:

16 Jul 2019 15:58

Publisher DOI:

10.1136/bmjopen-2018-026769

PubMed ID:

31164366

Uncontrolled Keywords:

clinical pharmacology general medicine (see internal medicine) geriatric medicine internal medicine

BORIS DOI:

10.7892/boris.131389

URI:

https://boris.unibe.ch/id/eprint/131389

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