Hospital physicians' and older patients' agreement with individualised STOPP/START-based medication optimisation recommendations in a clinical trial setting

C J A Huibers; B T G M Sallevelt; J M J Op Heij; D O'Mahony; N Rodondi; O Dalleur; R J van Marum; A C G Egberts; I Wilting; W Knol

doi:10.1007/s41999-022-00633-5

Hospital physicians' and older patients' agreement with individualised STOPP/START-based medication optimisation recommendations in a clinical trial setting

Eur Geriatr Med. 2022 Jun;13(3):541-552. doi: 10.1007/s41999-022-00633-5. Epub 2022 Mar 15.

Authors

C J A Huibers¹, B T G M Sallevelt², J M J Op Heij³, D O'Mahony⁴, N Rodondi^{5

6}, O Dalleur^{7

8}, R J van Marum^{9

10}, A C G Egberts^{2

11}, I Wilting², W Knol³

Affiliations

¹ Geriatric Medicine Department, University Medical Center Utrecht, Utrecht, The Netherlands. C.J.A.Huibers-3@umcutrecht.nl.
² Clinical Pharmacy Department, University Medical Center Utrecht, Utrecht, The Netherlands.
³ Geriatric Medicine Department, University Medical Center Utrecht, Utrecht, The Netherlands.
⁴ Department of Medicine (Geriatrics), University College Cork and Cork University Hospital, Cork, Ireland.
⁵ Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
⁶ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁷ Pharmacy Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Louvain, Belgium.
⁸ Louvain Drug Research Institute-Clinical Pharmacy, Université catholique de Louvain, Louvain, Belgium.
⁹ Department of Elderly Care Medicine, Amsterdam, UMC, Location VUmc, Amsterdam, The Netherlands.
¹⁰ Departments of Geriatrics and Clinical Pharmacology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
¹¹ Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.

Abstract

Objective: To evaluate the agreement of hospital physicians and older patients with individualised STOPP/START-based medication optimisation recommendations from a pharmacotherapy team.

Methods: This study was embedded within a large European, multicentre, cluster randomised controlled trial examining the effect of a structured medication review on drug-related hospital admissions in multimorbid (≥ 3 chronic conditions) older people (≥ 70 years) with polypharmacy (≥ 5 chronic medications), called OPERAM. Data from the Dutch intervention arm of this trial were used for this study. Medication review was performed jointly by a physician and pharmacist (i.e. pharmacotherapy team) supported by a Clinical Decision Support System with integrated STOPP/START criteria. Individualised STOPP/START-based medication optimisation recommendations were discussed with patients and attending hospital physicians.

Results: 139 patients were included, mean (SD) age 78.3 (5.1) years, 47% male and median (IQR) number of medications at admission 11 (9-14). In total, 371 recommendations were discussed with patients and physicians, overall agreement was 61.6% for STOPP and 60.7% for START recommendations. Highest agreement was found for initiation of osteoporosis agents and discontinuation of proton pump inhibitors (both 74%). Factors associated with higher agreement in multivariate analysis were: female gender (+ 17.1% [3.7; 30.4]), ≥ 1 falls in the past year (+ 15.0% [1.5; 28.5]) and renal impairment i.e. eGFR 30-50 ml/min/1.73 m²; (+ 18.0% [2.0; 34.0]). The main reason for disagreement (40%) was patients' reluctance to discontinue or initiate medication.

Conclusion: Better patient and physician education regarding the benefit/risk balance of pharmacotherapy, in addition to more precise and up-to-date medical records to avoid irrelevant recommendations, will likely result in higher adherence with future pharmacotherapy optimisation recommendations.

Clinical trial registration: Trial Registration Number NCT02986425.

Keywords: Multimorbidity; Pharmacotherapy optimisation; Polypharmacy; STOPP/START criteria; Shared-decision-making CDSS.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Female
Hospitals
Humans
Inappropriate Prescribing
Male
Physicians*
Polypharmacy
Potentially Inappropriate Medication List*

Associated data

ClinicalTrials.gov/NCT02986425