Intervention protocol: OPtimising thERapy to prevent avoidable hospital Admission in the Multi-morbid elderly (OPERAM): a structured medication review with support of a computerised decision support system

dc.contributor.authorCrowley, Erin K.
dc.contributor.authorSallevelt, Bastiaan T. G. M.
dc.contributor.authorHuibers, Corlina J. A.
dc.contributor.authorMurphy, Kevin D.
dc.contributor.authorSpruit, Marco
dc.contributor.authorShen, Zhengru
dc.contributor.authorBoland, Benoît
dc.contributor.authorSpinewine, Anne
dc.contributor.authorDalleur, Olivia
dc.contributor.authorMoutzouri, Elisavet
dc.contributor.authorLöwe, Axel
dc.contributor.authorFeller, Martin
dc.contributor.authorSchwab, Nathalie
dc.contributor.authorAdam, Luise
dc.contributor.authorWilting, Ingeborg
dc.contributor.authorKnol, Wilma
dc.contributor.authorRodondi, Nicholas
dc.contributor.authorByrne, Stephen
dc.contributor.authorO'Mahony, Denis
dc.contributor.funderHorizon 2020en
dc.contributor.funderStaatssekretariat für Bildung, Forschung und Innovation
dc.description.abstractBackground: Several approaches to medication optimisation by identifying drug-related problems in older people have been described. Although some interventions have shown reductions in drug-related problems (DRPs), evidence supporting the effectiveness of medication reviews on clinical and economic outcomes is lacking. Application of the STOPP/START (version 2) explicit screening tool for inappropriate prescribing has decreased inappropriate prescribing and significantly reduced adverse drug reactions (ADRs) and associated healthcare costs in older patients with multi-morbidity and polypharmacy. Therefore, application of STOPP/START criteria during a medication review is likely to be beneficial. Incorporation of explicit screening tools into clinical decision support systems (CDSS) has gained traction as a means to improve both quality and efficiency in the rather time-consuming medication review process. Although CDSS can generate more potential inappropriate medication recommendations, some of these have been shown to be less clinically relevant, resulting in alert fatigue. Moreover, explicit tools such as STOPP/START do not cover all relevant DRPs on an individual patient level. The OPERAM study aims to assess the impact of a structured drug review on the quality of pharmacotherapy in older people with multi-morbidity and polypharmacy. The aim of this paper is to describe the structured, multi-component intervention of the OPERAM trial and compare it with the approach in the comparator arm. Method: This paper describes a multi-component intervention, integrating interventions that have demonstrated effectiveness in defining DRPs. The intervention involves a structured history-taking of medication (SHiM), a medication review according to the systemic tool to reduce inappropriate prescribing (STRIP) method, assisted by a clinical decision support system (STRIP Assistant, STRIPA) with integrated STOPP/START criteria (version 2), followed by shared decision-making with both patient and attending physician. The developed method integrates patient input, patient data, involvement from other healthcare professionals and CDSS-assistance into one structured intervention. Discussion: The clinical and economical effectiveness of this experimental intervention will be evaluated in a cohort of hospitalised, older patients with multi-morbidity and polypharmacy in the multicentre, randomized controlled OPERAM trial (OPtimising thERapy to prevent Avoidable hospital admissions in the Multi-morbid elderly), which will be completed in the last quarter of 2019.en
dc.description.sponsorshipStaatssekretariat für Bildung, Forschung und Innovation (Swiss State Secretariat for Education, Research and Innovation (SERI) under contract number 15.0137)en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.identifier.citationCrowley, E. K., Sallevelt, B. T. G. M., Huibers, C. J. A., Murphy, K. D., Spruit, M., Shen, Z., Boland, B., Spinewine, A., Dalleur, O., Moutzouri, E., Löwe, A., Feller, M., Schwab, N., Adam, L., Wilting, I., Knol, W., Rodondi, N., Byrne, S. and O’Mahony, D. (2020) 'Intervention protocol: OPtimising thERapy to prevent avoidable hospital Admission in the Multi-morbid elderly (OPERAM): a structured medication review with support of a computerised decision support system', BMC Health Services Research, 20(1), 220 (12 pp). doi: 10.1186/s12913-020-5056-3en
dc.identifier.journaltitleBMC Health Services Researchen
dc.publisherBMC, Part of Springer Natureen
dc.relation.projectinfo:eu-repo/grantAgreement/EC/H2020::RIA/634238/EU/OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly/OPERAM
dc.rights© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.en
dc.subjectAdverse drug reactions (ADRs)en
dc.titleIntervention protocol: OPtimising thERapy to prevent avoidable hospital Admission in the Multi-morbid elderly (OPERAM): a structured medication review with support of a computerised decision support systemen
dc.typeArticle (peer-reviewed)en
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
2.27 MB
Adobe Portable Document Format
Published version
License bundle
Now showing 1 - 1 of 1
Thumbnail Image
2.71 KB
Item-specific license agreed upon to submission