198 CHAPTER 3.1 potentially inappropriate prescribing (PIP) or potential prescribing omissions (PPOs) [19]. STRIPA consists of four main components, i.e. functional architecture, user interface, decision rule engine, and semantic interoperability [20]. For the purpose of the multi-centre OPERAM trial, the STRIPA software was translated into four languages; English, German, French and Dutch. Integration of STOPP/START criteria into a stand-alone web-based clinical decision support system (CDSS) could improve the detection of inappropriate prescribing. A recent review has demonstrated that computerised interventions can significantly decrease PIP in hospitalised older adults, although the authors highlight that larger scale multinational RCTs are needed to support this contention [21]. Interestingly, other studies that investigated the benefits of medication review software based on clinical tools such as STOPP/START confirm the high identification rate of PIP, but address the fact that this can result in less clinically relevant recommendations being made [22]. Furthermore, it has been shown that the majority of DRPs identified during medication review may not be associated with the STOPP/START criteria [23]. Taken together, these results suggest that the application of STOPP/START alone does not adequately detect all drug-related errors and that consequently a more complex intervention is necessary to optimise the medication review process. Therefore, a structured assessment, including a patient interview that identifies health and medication issues, combined with a medication review facilitated by a CDSS and evaluated by trained healthcare professionals, could potentially identify the most relevant drug-related problems. The aim of the OPERAM study is to assess the impact of a structured drug review utilising the STRIP method, including STRIPA software, on the quality of pharmacotherapy and whether such optimisation of pharmacotherapy in older people can reduce the number of drug-related hospital admissions in older patients with multi-morbidity and polypharmacy hospitalised previously (i.e. at enrolment into OPERAM) [24]. The trial protocol has been described elsewhere [25]; the aim of this report is to describe the structured, multi-component intervention and compare it with the approach in the comparator arm (see Figure 1). This protocol has been written in line with Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) recommendations.
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