OPTimization of Medication by transdisciplinary Assessment of drug Treatment in Elderly hospitizalised patients (OPTIMATE): application of a definitive intervention by physicians or clinical pharmacists

Older people commonly experience multimorbid illness i.e. several chronic medical conditions occurring in the same patient simultaneously. Each of these conditions is usually treated with one or more medications, such that multimorbid illness usually results in several medications being simultaneously prescribed long-term; this is referred to as polypharmacy. Polypharmacy increases the risk of inappropriate medications which in turn increases the risk of adverse drug reactions, or ADRs. ADRs are a common cause of hospitalization and emergency department attendance in the adult population in general and in the over-70’s population in particular which is costly but preventable. Hospitalized older people are at highest risk of ADRs and are therefore the focus of this research proposal.

In recent years, several methods of improving the quality of prescribing in older people have been devised and tested. These include structured medication review, criteria for highlighting potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) of important medications called STOPP/START criteria, feedback to prescribers and interviews with patients aimed at early detection and correction of medication-related problems. A recent clinical trial showed that ADRs can be reduced in hospitalized older people by means of a trained physician applying STOPP/START criteria shortly after admission and highlighting PIMs and PPOs to attending doctors. A structured clinical pharmacist's review of medication also reduces ADRs in older hospitalized patients but to a lesser extent.

The OPTIMATE clinical trial aims to examine the effect of a multi-faceted intervention designed to optimize medication in hospitalized multi-morbid older people exposed to polypharmacy on unplanned hospital readmission and emergency department attendance. The intervention aims to minimize potentially inappropriate medications in a structured way and involves follow-up with patients and GPs. Patients will be allocated equally to (i) standard medication management (control arm) or (ii) trained physician-delivered intervention or (iii) clinical pharmacist-delivered intervention.

Award Date
04 December 2020
Award Value
Principal Investigator
Professor Denis O'Mahony
Host Institution
University College Cork
DIFA 2020