Background: Medication-related harm includes adverse drug reactions (ADRs; noxious and unintended responses to medicinal products) and adverse drug events (ADEs; injuries related to medicine use). Approximately 10% of hospital admissions in older populations are attributable to medication-related harm. The WHO Global Patient Safety Challenge: ‘Medication without harm’ aims to reduce the level of severe, avoidable harm related to medications by 50% over 5 years, globally. In Ireland, the Health Service Executive (HSE) National Quality Improvement Team (NQIT) is leading this challenge. Aim: To establish the scope and nature of medication-related harm in older populations in Ireland with the HSE NQIT. Methods: Four inter-related work-packages are proposed using three prospective longitudinal ageing cohorts (Adverse Drug Reactions in an Ageing PopulaTion (ADAPT), Centre for Primary Care Research (CPCR) and The Irish LongituDinal Study of Ageing linked to pharmacy claims data (TILDA-PCRS). Work-package 1, building on our previous research, will identify the high-risk medications and risk factors associated with ADR-related hospital admissions, develop risk prediction models, which identify older people at high risk of medication-related harm and compare these models to other existing models. Work-package 2 will establish the adverse health outcomes associated with medication-related harm and validate the newly developed risk prediction models. Work-package 3 will examine the effect of changes in high-risk medication, including discontinuation, switching of therapy or dose changes on reducing medication-related harm. Work-package 4 will explore extending this research internationally and assess the population risk of medication-related harm in Europe. Potential impact: To date implementation of medicines optimisation initiatives has been suboptimal due to a gap between policy initiatives and practice. Identifying the individuals and groups of older people where there is greatest impact from stopping/reducing high-risk medication is essential to enable the HSE and the health service target supports to those most likely to benefit from then.
