Bastiaan Sallevelt

197 OPERAM: intervention protocol Introduction The global population aged over 65years is rapidly increasing such that by 2060 approximately one-third of the European population is projected to be over 65years [1]. In this ageing population, there is a higher prevalence of multi-morbidity, which is in turn associated with greater mortality [2], decreased quality of life (QoL) and increased number of hospital admissions [3]. Moreover, these patients are frequently exposed to multiple medications in the context of their multi-morbidity i.e. multiple chronic diseases usually engender multiple prescriptions, also known as polypharmacy. Although polypharmacy has several definitions, the most broadly accepted is that of the concurrent use of ≥5 medications [4]. Polypharmacy in older patients has been repeatedly shown to result in negative consequences such as increased healthcare costs, adverse drug reactions (ADRs), adverse drug-drug interactions (DDI) and drug-related hospital admissions [5–7]. Importantly, the risk of either ADR or DDI occurrence increases with the number of medications prescribed [8, 9]. Despite this, a recent study demonstrated that across specific European countries, the issue of problematic polypharmacy has not been widely addressed [10]. Several different approaches to optimise prescription medication in older people have been reported [11, 12]. In spite of a general lack of evidence for their significant impact on health-related outcomes, a Cochrane review did find that one particular approach was beneficial in reducing inappropriate polypharmacy [13], i.e. the novel geriatric-specific inappropriate prescribing criteria called Screening Tool of Older Persons’ Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) [14]. The first of a series of 5 randomised controlled trials (RCTs) using the STOPP/START criteria as an intervention demonstrated that the use of these criteria significantly improved prescribing appropriateness up to 6months after discharge in a cohort of older, hospitalised patients [9]. Further refinements to the criteria resulted in the publication of STOPP/START version 2 [15] and subsequent studies have shown that application of STOPP/START criteria can reduce both the incidence of ADRs and medication costs in older, hospitalised patients [16, 17]. Application of the STOPP/START version 2 criteria into a structured medication review process is defined as the Systematic Tool to Reduce Inappropriate Prescribing (STRIP) [18]. More recently, the European Commission and Swiss Government-funded OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in the Multi-morbid elderly) project was established based on the use of the STRIP medication review. The STRIP process encompasses the use of a customised software-based tool known as the STRIP Assistant (STRIPA), which was developed to support healthcare professionals to perform the STRIP medication review process. The STRIPA process then generates a report with prescribing recommendations addressing 3