Bastiaan Sallevelt

21 General Introduction Thesis outline Chapter 2 describes the applicability of medication optimisation tools recommended by clinical practice guidelines. In Chapter 2.1, the performance of a trigger tool for detecting adverse drug reactions is evaluated. This ADR trigger tool has been recommended for use in all acutely admitted older patients with polypharmacy by the Dutch geriatric guideline on ‘polypharmacy optimisation in hospitalised older people’. In Chapter 2.2, the clarity of STOPP/START version 2 as a clinical practice guideline for applicability in daily patient care is evaluated. The conversion of STOPP/START criteria version 2 into software algorithms to enable their incorporation into a CDSS is described in Chapter 2.3. Chapter 3 focuses on the process development of a CDSS-assisted in-hospital medication review (Chapter 3.1) and its effect on clinical outcomes in hospitalised older people with multimorbidity and polypharmacy (Chapter 3.2). This research is part of the OPERAM trial, a European cluster-randomised controlled multicentre trial investigating the effect of a STOPP/START-based in-hospital medication review on drug-related readmissions in older (≥ 70 years) patients with multimorbidity (≥3 chronic conditions) and polypharmacy (≥5 regular medication use). Secondary outcomes are based on the aforementioned core outcome set [85]. The in-hospital medication review is performed according to the STRIP method supported by STRIPA software with incorporated STOPP/START version 2. Chapter 4 evaluates the process of in-hospital medication reviews performed in the OPERAM trial on three levels. In Chapter 4.1, the clinical applicability of CDSS-generated STOPP/START signals in a hospital setting is evaluated. Second, the patients’ and physicians’ agreement with STOPP/START-based individualised medication optimisation recommendations are assessed in Chapter 4.2. In Chapter 4.3, the detectability of medication errors with the in-hospital medication review in the year prior to a potentially preventable drug-related hospital admission is assessed. The thesis outline is graphically summarised in Figure 6. 1