TY - JOUR T1 - Rationale and design of OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people (OPERAM): a cluster randomised controlled trial JF - BMJ Open JO - BMJ Open DO - 10.1136/bmjopen-2018-026769 VL - 9 IS - 6 SP - e026769 AU - Luise Adam AU - Elisavet Moutzouri AU - Christine Baumgartner AU - Axel Lennart Loewe AU - Martin Feller AU - Khadija M’Rabet-Bensalah AU - Nathalie Schwab AU - Stefanie Hossmann AU - Claudio Schneider AU - Sabrina Jegerlehner AU - Carmen Floriani AU - Andreas Limacher AU - Katharina Tabea Jungo AU - Corlina Johanna Alida Huibers AU - Sven Streit AU - Matthias Schwenkglenks AU - Marco Spruit AU - Anette Van Dorland AU - Jacques Donzé AU - Patricia M Kearney AU - Peter Jüni AU - Drahomir Aujesky AU - Paul Jansen AU - Benoit Boland AU - Olivia Dalleur AU - Stephen Byrne AU - Wilma Knol AU - Anne Spinewine AU - Denis O’Mahony AU - Sven Trelle AU - Nicolas Rodondi Y1 - 2019/06/01 UR - http://bmjopen.bmj.com/content/9/6/e026769.abstract N2 - Introduction Multimorbidity and polypharmacy are important risk factors for drug-related hospital admissions (DRAs). DRAs are often linked to prescribing problems (overprescribing and underprescribing), as well as non-adherence with drug regimens for different reasons. In this trial, we aim to assess whether a structured medication review compared with standard care can reduce DRAs in multimorbid older patients with polypharmacy.Methods and analysis OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people is a European multicentre, cluster randomised, controlled trial. Hospitalised patients ≥70 years with ≥3 chronic medical conditions and concurrent use of ≥5 chronic medications are included in the four participating study centres of Bern (Switzerland), Utrecht (The Netherlands), Brussels (Belgium) and Cork (Ireland). Patients treated by the same prescribing physician constitute a cluster, and clusters are randomised 1:1 to either standard care or Systematic Tool to Reduce Inappropriate Prescribing (STRIP) intervention with the help of a clinical decision support system, the STRIP Assistant. STRIP is a structured method performing customised medication reviews, based on Screening Tool of Older People’s Prescriptions/Screening  Tool to Alert to Right Treatment criteria to detect potentially inappropriate prescribing. The primary endpoint is any DRA where the main reason or a contributory reason for the patient’s admission is caused by overtreatment or undertreatment, and/or inappropriate treatment. Secondary endpoints include number of any hospitalisations, all-cause mortality, number of falls, quality of life, degree of polypharmacy, activities of daily living, patient’s drug compliance, the number of significant drug–drug interactions, drug overuse and underuse and potentially inappropriate medication.Ethics and dissemination The local Ethics Committees in Switzerland, Ireland, The Netherlands and Belgium approved this trial protocol. We will publish the results of this trial in a peer-reviewed journal.Main funding European Union’s Horizon 2020 programme.Trial registration number NCT02986425 , SNCTP000002183 , NTR6012, U1111-1181-9400. ER -