Hospital physicians’ and older patients’ agreement with individualised STOPP/START-based medication optimisation recommendations in a clinical trial setting
Key Summary Points Aim To evaluate the agreement of hospital physicians and older patients with individualised STOPP/START based medication optimisation recommendations from a pharmacotherapy team. Findings In total, 371 recommendations were discussed with patients and physicians, overall agreement...
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| Veröffentlicht in: | European geriatric medicine 2022-06, Vol.13 (3), p.541-552 |
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| creator | Huibers, C. J. A. Sallevelt, B. T. G. M. Heij, J. M. J. op O’Mahony, D. Rodondi, N. Dalleur, O. van Marum, R. J. Egberts, A. C. G. Wilting, I. Knol, W. |
| description | Key Summary Points
Aim
To evaluate the agreement of hospital physicians and older patients with individualised STOPP/START based medication optimisation recommendations from a pharmacotherapy team.
Findings
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 (74%) was found for initiation of osteoporosis agents and discontinuation of proton pump inhibitors.
Message
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.
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 m
2
; (+ 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 benefi |
| doi_str_mv | 10.1007/s41999-022-00633-5 |
| format | Article |
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Aim
To evaluate the agreement of hospital physicians and older patients with individualised STOPP/START based medication optimisation recommendations from a pharmacotherapy team.
Findings
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 (74%) was found for initiation of osteoporosis agents and discontinuation of proton pump inhibitors.
Message
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.
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 m
2
; (+ 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.</description><identifier>ISSN: 1878-7649</identifier><identifier>ISSN: 1878-7657</identifier><identifier>EISSN: 1878-7657</identifier><identifier>DOI: 10.1007/s41999-022-00633-5</identifier><identifier>PMID: 35291025</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Geriatrics/Gerontology ; Internal Medicine ; Medicine ; Medicine & Public Health ; NCT ; NCT02986425 ; Research Paper</subject><ispartof>European geriatric medicine, 2022-06, Vol.13 (3), p.541-552</ispartof><rights>The Author(s) 2022</rights><rights>2022. The Author(s).</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c446t-be25afc8a479b23f2ed8a178aeee0b94bef482ce1c4df4c71e4b85f05327e9173</citedby><cites>FETCH-LOGICAL-c446t-be25afc8a479b23f2ed8a178aeee0b94bef482ce1c4df4c71e4b85f05327e9173</cites><orcidid>0000-0002-2861-0068</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s41999-022-00633-5$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s41999-022-00633-5$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,778,782,883,27907,27908,41471,42540,51302</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35291025$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Huibers, C. J. A.</creatorcontrib><creatorcontrib>Sallevelt, B. T. G. M.</creatorcontrib><creatorcontrib>Heij, J. M. J. op</creatorcontrib><creatorcontrib>O’Mahony, D.</creatorcontrib><creatorcontrib>Rodondi, N.</creatorcontrib><creatorcontrib>Dalleur, O.</creatorcontrib><creatorcontrib>van Marum, R. J.</creatorcontrib><creatorcontrib>Egberts, A. C. G.</creatorcontrib><creatorcontrib>Wilting, I.</creatorcontrib><creatorcontrib>Knol, W.</creatorcontrib><title>Hospital physicians’ and older patients’ agreement with individualised STOPP/START-based medication optimisation recommendations in a clinical trial setting</title><title>European geriatric medicine</title><addtitle>Eur Geriatr Med</addtitle><addtitle>Eur Geriatr Med</addtitle><description>Key Summary Points
Aim
To evaluate the agreement of hospital physicians and older patients with individualised STOPP/START based medication optimisation recommendations from a pharmacotherapy team.
Findings
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 (74%) was found for initiation of osteoporosis agents and discontinuation of proton pump inhibitors.
Message
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.
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 m
2
; (+ 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.</description><subject>Geriatrics/Gerontology</subject><subject>Internal Medicine</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>NCT</subject><subject>NCT02986425</subject><subject>Research Paper</subject><issn>1878-7649</issn><issn>1878-7657</issn><issn>1878-7657</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><recordid>eNp9UcFuFSEUnRiNbWp_wIVh6WYsMPAYNiZNo7ZJkzb2uSYMc-c9GgZGYNp052-489v8Enmd9kU3sgDuvecc7uVU1VuCPxCMxUliREpZY0prjFdNU_MX1SFpRVuLFRcv93cmD6rjlG5xWQ2VUrDX1UHDqSSY8sPq13lIk83aoWn7kKyx2qffP34i7XsUXA8RTTpb8HnJbiLAWCJ0b_MWWd_bO9vP2tkEPbpZX11fn9ysT7-u607vMiP01hR-8ChM2Y42LUEEE8ai0z-GqQghjYyzvqAdytGWPUHO1m_eVK8G7RIcP51H1bfPn9Zn5_Xl1ZeLs9PL2jC2ynUHlOvBtJoJ2dFmoNC3mohWAwDuJOtgYC01QAzrB2YEAda1fMC8oQIkEc1R9XHRneautG3KkFE7NUU76viggrbq34q3W7UJd0oSTjhrisD7J4EYvs-QsirjGnBOewhzUnTFMGZCiB2ULlATQ0oRhv0zBKudu2pxVxV31aO7ihfSu78b3FOevSyAZgGkUvIbiOo2zNGXT_uf7B_kKbfh</recordid><startdate>20220601</startdate><enddate>20220601</enddate><creator>Huibers, C. J. A.</creator><creator>Sallevelt, B. T. G. M.</creator><creator>Heij, J. M. J. op</creator><creator>O’Mahony, D.</creator><creator>Rodondi, N.</creator><creator>Dalleur, O.</creator><creator>van Marum, R. J.</creator><creator>Egberts, A. C. G.</creator><creator>Wilting, I.</creator><creator>Knol, W.</creator><general>Springer International Publishing</general><scope>C6C</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-2861-0068</orcidid></search><sort><creationdate>20220601</creationdate><title>Hospital physicians’ and older patients’ agreement with individualised STOPP/START-based medication optimisation recommendations in a clinical trial setting</title><author>Huibers, C. J. A. ; Sallevelt, B. T. G. M. ; Heij, J. M. J. op ; O’Mahony, D. ; Rodondi, N. ; Dalleur, O. ; van Marum, R. J. ; Egberts, A. C. G. ; Wilting, I. ; Knol, W.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c446t-be25afc8a479b23f2ed8a178aeee0b94bef482ce1c4df4c71e4b85f05327e9173</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Geriatrics/Gerontology</topic><topic>Internal Medicine</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>NCT</topic><topic>NCT02986425</topic><topic>Research Paper</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Huibers, C. J. A.</creatorcontrib><creatorcontrib>Sallevelt, B. T. G. M.</creatorcontrib><creatorcontrib>Heij, J. M. J. op</creatorcontrib><creatorcontrib>O’Mahony, D.</creatorcontrib><creatorcontrib>Rodondi, N.</creatorcontrib><creatorcontrib>Dalleur, O.</creatorcontrib><creatorcontrib>van Marum, R. J.</creatorcontrib><creatorcontrib>Egberts, A. C. G.</creatorcontrib><creatorcontrib>Wilting, I.</creatorcontrib><creatorcontrib>Knol, W.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European geriatric medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Huibers, C. J. A.</au><au>Sallevelt, B. T. G. M.</au><au>Heij, J. M. J. op</au><au>O’Mahony, D.</au><au>Rodondi, N.</au><au>Dalleur, O.</au><au>van Marum, R. J.</au><au>Egberts, A. C. G.</au><au>Wilting, I.</au><au>Knol, W.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hospital physicians’ and older patients’ agreement with individualised STOPP/START-based medication optimisation recommendations in a clinical trial setting</atitle><jtitle>European geriatric medicine</jtitle><stitle>Eur Geriatr Med</stitle><addtitle>Eur Geriatr Med</addtitle><date>2022-06-01</date><risdate>2022</risdate><volume>13</volume><issue>3</issue><spage>541</spage><epage>552</epage><pages>541-552</pages><issn>1878-7649</issn><issn>1878-7657</issn><eissn>1878-7657</eissn><abstract>Key Summary Points
Aim
To evaluate the agreement of hospital physicians and older patients with individualised STOPP/START based medication optimisation recommendations from a pharmacotherapy team.
Findings
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 (74%) was found for initiation of osteoporosis agents and discontinuation of proton pump inhibitors.
Message
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.
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 m
2
; (+ 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.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>35291025</pmid><doi>10.1007/s41999-022-00633-5</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-2861-0068</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | European geriatric medicine, 2022-06, Vol.13 (3), p.541-552 |
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| language | eng |
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| subjects | Geriatrics/Gerontology Internal Medicine Medicine Medicine & Public Health NCT NCT02986425 Research Paper |
| title | Hospital physicians’ and older patients’ agreement with individualised STOPP/START-based medication optimisation recommendations in a clinical trial setting |
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