Cost-Effectiveness Analysis of a Physician-Implemented Medication Screening Tool in Older Hospitalised Patients in Ireland

O’Brien, Gary L.; O’Mahony, Denis; Gillespie, Paddy; Mulcahy, Mark; Walshe, Valerie; O’Connor, Marie; O’Sullivan, David; Gallagher, James; Byrne, Stephen

doi:10.1007/s40266-018-0564-0

Cited by 13 publications

(1 citation statement)

References 53 publications

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“…The trained physician applied STOPP/START criteria to the medications of intervention arm patients within 48 hours of admission and provided the details of the contravened STOPP/START criteria in person to the attending senior residents or consultants, supplemented by an individualized printed report. Although delivery of STOPP/START criteria advice by a trained physician is highly effective for ADR prevention, it is however unlikely to be cost-effective 35 . The SENATOR trial aimed to match the performance of the earlier single centre trial but in a multi-centre context using software-generated advice reports only (as distinct from physician-delivered and moderated reports) i.e.…”

Section: Discussionmentioning

confidence: 99%

Prevention of adverse drug reactions in hospitalized older patients with multi-morbidity and polypharmacy: the SENATOR* randomized controlled clinical trial

et al. 2020

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Abstract Background Multi-morbidity and polypharmacy increase the risk of non-trivial adverse drug reactions (ADRs) in older people during hospitalization. Despite this, there are no established interventions for hospital-acquired ADR prevention. Methods We undertook a pragmatic, multi-national, parallel arm prospective randomized open-label, blinded endpoint (PROBE) controlled trial enrolling patients at six European medical centres. We randomized 1,537 older medical and surgical patients with multi-morbidity and polypharmacy on admission in a 1:1 ratio to SENATOR software-guided medication optimization plus standard care (intervention, n = 772, mean number of daily medications = 9.34) or standard care alone (control, n = 765, mean number of daily medications = 9.23) using block randomization stratified by site and admission type. Attending clinicians in the intervention arm received SENATOR-generated advice at a single time point with recommendations they could choose to adopt or not. The primary endpoint was occurrence of probable or certain ADRs within 14 days of randomization. Secondary endpoints were primary endpoint derivatives; tertiary endpoints included all-cause mortality, re-hospitalization, composite healthcare utilization and health-related quality of life. Results For the primary endpoint, there was no difference between the intervention and control groups (24.5 vs. 24.8%; OR 0.98; 95% CI 0.77–1.24; P = 0.88). Similarly, with secondary and tertiary endpoints, there were no significant differences. Among attending clinicians in the intervention group, implementation of SENATOR software-generated medication advice points was poor (~15%). Conclusions In this trial, uptake of software-generated medication advice to minimize ADRs was poor and did not reduce ADR incidence during index hospitalization.

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Section: Discussionmentioning

confidence: 99%

Prevention of adverse drug reactions in hospitalized older patients with multi-morbidity and polypharmacy: the SENATOR* randomized controlled clinical trial

et al. 2020

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Medication review in hospitalised patients to reduce morbidity and mortality

Bülow

Clausen

Lundh

et al. 2023

Cochrane Database of Systematic Reviews

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INTERPOLAR – prospektive, interventionelle Studien im Rahmen der Medizininformatik-Initiative zur Verbesserung der Arzneimitteltherapiesicherheit in der Krankenversorgung

Loeffler,

Maas,

Neumann

et al. 2024

Bundesgesundheitsbl

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ZusammenfassungMedikationsanalysen durch Stationsapotheker:innen sind eine wichtige Maßnahme der Arzneimitteltherapiesicherheit (AMTS). Dabei werden medikationsbezogene Probleme (Medication Related Problems [MRPs]) identifiziert und zusammen mit den behandelnden Ärzt:innen gelöst. Die Personalressourcen für erweiterte Medikationsanalysen und eine vollständige Dokumentation sind jedoch häufig begrenzt. Bisher müssen Daten, die für die Identifikation von Risikopatient:innen und für eine erweiterte Medikationsanalyse benötigt werden, oft aus verschiedenen Teilen der einrichtungsinternen elektronischen Patientenakte („Electronic Medical Record“ [EMR]) zusammengesucht werden. Dieser fehleranfällige und zeitaufwändige Prozess soll im Projekt INTERPOLAR durch die Nutzung eines durch die Datenintegrationszentren (DIZ) bereitgestellten IT-Werkzeuges verbessert werden.INTERPOLAR (INTERventional POLypharmacy – Drug InterActions – Risks) ist ein „Use Case“ der Medizininformatik-Initiative (MII), der auf das Thema AMTS fokussiert. Die Planungsphase fand im Jahr 2023 statt, die Routineimplementation ist ab 2024 vorgesehen. AMTS-relevante Daten aus dem EMR sollen dargestellt und die Dokumentation der MRPs in der Routineversorgung erleichtert werden. Die prospektive multizentrische, clusterrandomisierte INTERPOLAR-1-Studie dient dazu, den Nutzen der IT-Unterstützung in der Routineversorgung zu evaluieren. Ziel ist es, zu zeigen, dass mithilfe der IT-Unterstützung mehr MRPs entdeckt und auch gelöst werden können. Dazu werden an 8 Universitätskliniken jeweils 6 Normalstationen ausgewählt, sodass 48 Cluster (mit insgesamt mindestens 70.000 Fällen) zur Randomisierung bereitstehen.

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Cost-Effectiveness Analysis of a Physician-Implemented Medication Screening Tool in Older Hospitalised Patients in Ireland

Cited by 13 publications

References 53 publications

Prevention of adverse drug reactions in hospitalized older patients with multi-morbidity and polypharmacy: the SENATOR* randomized controlled clinical trial

Prevention of adverse drug reactions in hospitalized older patients with multi-morbidity and polypharmacy: the SENATOR* randomized controlled clinical trial

Medication review in hospitalised patients to reduce morbidity and mortality

INTERPOLAR – prospektive, interventionelle Studien im Rahmen der Medizininformatik-Initiative zur Verbesserung der Arzneimitteltherapiesicherheit in der Krankenversorgung

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