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Optimizing Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older Adults (OPERAM): cluster randomised
Manuel R Blum1,2, Bastiaan T G M Sallevelt3, Anne Spinewine4,5
1Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
BMJ (Clinical Research Ed.)
|July 14, 2021
Summary
Optimizing drug treatment reduced inappropriate prescribing in older adults with multiple conditions but did not decrease hospital admissions. Further research is needed for interventions that improve patient outcomes.
Area of Science:
- Geriatric Medicine
- Clinical Pharmacy
- Public Health
Background:
- Older adults with multimorbidity and polypharmacy are at high risk for drug-related hospital admissions.
- Inappropriate prescribing is a significant contributor to adverse drug events in this population.
Purpose of the Study:
- To evaluate the impact of a pharmacotherapy optimization intervention on drug-related hospital admissions in elderly patients with multiple chronic conditions and polypharmacy.
Main Methods:
- A cluster randomized controlled trial involving 2008 older adults across university hospitals in four European countries.
- The intervention involved a structured pharmacotherapy optimization by doctors and pharmacists using the STOPP/START criteria.
- The primary outcome was the first drug-related hospital admission within 12 months.
Main Results:
- The intervention successfully reduced inappropriate prescribing in 86.1% of participants.
- No significant difference was observed in drug-related hospital admissions between the intervention (21.9%) and control (22.4%) groups.
- Hazard ratios for drug-related admissions, falls, and death did not show statistically significant reductions.
Conclusions:
- Pharmacotherapy optimization interventions can decrease inappropriate prescribing in older adults with multimorbidity and polypharmacy.
- Current interventions may not be sufficient to reduce drug-related hospital admissions in this population.
- Further research is required to develop effective strategies for improving patient outcomes through pharmacotherapy optimization.
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