Medicines Optimisation Assessment Tool (MOAT): a prognostic model to target hospital pharmacists' input to improve patient outcomes. Protocol for an observational study

Abstract

IntroductionMedicines optimisation is a key role for hospital pharmacists, but with ever-increasing demands on services there is a need to increase efficiency while maintaining patient safety. The aim of this study is to develop a prognostic model, the Medicines Optimisation Assessment Tool (MOAT), which can be used to target patients most in need of pharmacists' input while in hospital.Methods and analysisThe MOAT will be developed following recommendations of the Prognosis Research Strategy partnership. Using a cohort study we will prospectively include 1500 adult patients from the medical wards of two UK hospitals. Data on medication-related problems (MRPs) experienced by study patients will be collected by pharmacists at the study sites as part of their routine daily clinical assessment of patients. Data on potential risk factors such as polypharmacy, renal impairment and the use of 'high risk' medicines will be collected retrospectively from the information departments at the study sites, laboratory reporting systems and patient medical records. Multivariable logistic regression models will then be used to determine the relationship between potential risk factors and the study outcome of preventable MRPs that are at least moderate in severity. Bootstrapping will be used to adjust the MOAT for optimism, and predictive performance will be assessed using calibration and discrimination. A simplified scoring system will also be developed, which will be assessed for sensitivity and specificity.Ethics and disseminationThis study has been approved by the Proportionate Review Service Sub-Committee of the National Health Service Research Ethics Committee Wales REC 7 (16/WA/0016) and the Health Research Authority (project ID 197298). We plan to disseminate the results via presentations at relevant patient/public, professional, academic and scientific meetings and conferences, and will submit findings for publication in peer-reviewed journals.Trial registration numberNCT02582463.

Development and performance evaluation of the Medicines Optimisation Assessment Tool (MOAT): a prognostic model to target hospital pharmacists’ input to prevent medication-related problems

“…The MOAT was developed using a prospective cohort study involving adults admitted to the medical wards of two hospitals in South East England, described in detail in a published protocol 32. Eligible patients were consecutively included at Hospital A from 28 April 2016 to 31 May 2016 and Hospital B from 19 October 2016 to 1 November 2016.…”

Analysis of pharmacist-identified medication-related problems at two United Kingdom hospitals: a prospective observational study

“…This prospective study, using an observational study design, involved patients admitted to 30 adult medical wards at two hospitals in South East England. This has been described in detail elsewhere 13,29,30. In summary, the study sites were acute district general hospitals, each with approximately 600 inpatient beds, and broadly representative of other general (non‐specialist) acute NHS trusts in England 30.…”

“…As reported elsewhere,29 MRPs were defined as ‘all circumstances involving a patient’s drug treatment that actually, or potentially, interfere with the achievement of an optimal outcome’ 31. We chose to study MRPs that were at least moderate in severity to inform targeting of patients at highest risk of medication‐related harm.…”

High‐risk medicines associated with clinically relevant medication‐related problems in UK hospitals: A prospective observational study

“…This prospective observational study involved adults admitted to the medical wards of 2 hospitals in South East England, described in detail elsewhere . A summary is provided in Appendix S1.…”