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Hospital physicians’ and older patients’ agreement with individualised STOPP/START based medication optimisation recommendations in a clinical trial setting
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  • C.J.A. (Lianne) Huibers,
  • Bastiaan Sallevelt,
  • Jody Op Heij,
  • Denis O'Mahony,
  • Nicolas Rodondi,
  • Olivia Dalleur,
  • Rob van Marum,
  • Toine Egberts,
  • Ingeborg Wilting,
  • Wilma Knol
C.J.A. (Lianne) Huibers
University Medical Centre Utrecht Internal Medicine and Dermatology

Corresponding Author:c.j.a.huibers-3@umcutrecht.nl

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Bastiaan Sallevelt
University Medical Centre Utrecht
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Jody Op Heij
University Medical Centre Utrecht Internal Medicine and Dermatology
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Denis O'Mahony
Cork University Hospital
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Nicolas Rodondi
University of Bern
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Olivia Dalleur
Université catholique de Louvain
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Rob van Marum
Jeroen Bosch Hospital
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Toine Egberts
University Medical Center Utrecht
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Ingeborg Wilting
University Medical Center Utrecht
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Wilma Knol
University Medical Centre Utrecht Internal Medicine and Dermatology
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Abstract

OBJECTIVE: To evaluate 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). 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). 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%). Determinants 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 eGFR 30-50 ml/min/1.73m2; (+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 invalid recommendations, will likely result in higher agreement with future pharmacotherapy optimisation recommendations.