Bastiaan Sallevelt

17 General Introduction 4. Shared decision-making: Collaborating between patients and healthcare professionals to jointly decide therapeutic aims and pharmacotherapy; 5. Follow-up and monitoring: Determining patient outcomes based on the desired goals of pharmacotherapy. The steps of a medication review according to the STRIP method and tools to facilitate this process appear in Figure 5. Medication reconciliation is the first step in the medication review process and aims to obtain and maintain a complete and accurate list of a patient’s current medication use – both prescription and non-prescription drugs – particularly at care transitions [68]. The Structured History-taking of Medication (SHiM) tool was developed to reduce the number of unintentional medication discrepancies [69]. This implicit screening tool revealed unintentional discrepancies in medication lists of 92% of patients admitted to the geriatric ward, of which one-fifth had clinical consequences [69]. Unintentional discrepancies in medication lists at hospital discharge to the less controlled primary care environment pose an even higher risk for patient harm [70,71]. Van der Linden et al. found that more than a quarter (27%) of discontinued drugs during hospitalisation because of an adverse drug reaction were represcribed after discharge from geriatric wards [72]. Medication reconciliation effectively decreases admission and discharge order discrepancies, possibly reducing preventable medication harm [73,74]. Hence, the integration of medication reconciliation by pharmacy technicians at transitions of care has been implemented as a standard of care for several years in Dutch hospitals [75,76]. However, performing a complete medication review using the STRIP method is time-consuming. Therefore, computerised interventions have been suggested to increase the efficacy and quality of the medication review process in older people [55]. Explicit screening tools, such as STOPP/START, have the potential to be implemented as algorithms in clinical decision support systems (CDSS), thereby facilitating the pharmacotherapy analysis (step 2) of themedication reviewprocess [77]. The STRIP Assistant (STRIPA) is a Dutch software-based CDSS first developed in 2015 to assist healthcare professionals in performing a pharmacotherapy analysis during a medication review. This prototype of STRIPA included STOPP/START criteria version 1, intended for use in primary care [78]. Its performance was tested in a validation study among general practitioners and pharmacists. STRIPA increased correct decisions from 58% to 76% (p < 0.01) and reduced incorrect decisions 1