Medication review to prevent avoidable hospital admissions in older with multi-morbidity : measuring outcomes that matter to patients

Abstract

Inappropriate polypharmacy and related adverse health outcomes represent significant challenges in the ageing multi-morbid population. Medication reviews are recommended to reduce inappropriate polypharmacy and a patient-centred approach to medication review is considered essential. In this context, the European OPERAM trial was undertaken to evaluate the impact of medication review on drug-related readmissions in 2009 multi-morbid older patients. This thesis aimed to inform medication review in older people with multi-morbidity and polypharmacy by measuring outcomes that matter to patients. We developed the first standardised method to identify drug-related admissions (DRAs) in older people, a growing patient safety threat and an outcome of medication review that is considered highly important to older people. We highlighted the challenges associated with achieving good inter-rater reliability in DRA adjudication. In a cross-sectional study, we demonstrated that DRAs resulting from inappropriate prescribing detected by the STOPP/START.v2 criteria accounted for 40% of admissions in older patients. In a multi-centre mixed methods study embedded in OPERAM, we evaluated the patient experience. We showed that patients’ attitudes towards hospital-initiated medication changes and medication review were generally positive, but an interplay of factors related to inadequate information and communication, paternalism, patients’ beliefs, clinicians’ attitudes and doctor-patient relationships may affect effectiveness of medication reviews. Finally, a scoping review will help to increase understanding of medication-related preferences of multi-morbid older people, in order to inform medication review. Our findings pave the way for a better measurement and understanding of DRAs and for medication review services to become more tailored to the needs and preferences of older people with multi-morbidity and polypharmacy.(BIFA - Sciences biomédicales et pharmaceutiques) -- UCL, 202