Evidence map›Paper›PMID 34257088›Full record

Trial reportBMJ (Clinical research ed.)2021

Optimizing Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older Adults (OPERAM): cluster randomised controlled trial.

Manuel R Blum, Bastiaan T G M Sallevelt, Anne Spinewine, Denis O'Mahony, Elisavet Moutzouri, Martin Feller, Christine Baumgartner, Marie Roumet, Katharina Tabea Jungo, Nathalie Schwab and 35 more

Erratum issued 2 registry-linked trialsOpen access · hybridAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ (Clinical research ed.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to 2 registered trials, which are not on this map. Cited by 122 papers, 16 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
122citing papers in PubMed, 16 pooled it
17.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02986425 nacompletednot on this map

OPERAM: OPtimising thERapy to Prevent Avoidable Hospital Admissions in the Multimorbid Older People: a Cluster Randomised Controlled Trial

TypeinterventionalSponsorInsel Gruppe AG, University Hospital BernRan2016 to 2019Enrolled2,009Conditions3 or More Chronic Conditions for 6 Months or Longer, 5 or More Regular DrugsArmsSTRIP intervention, Control
NCT05387096 naunknown statusnot on this mapstarted 2023, after this paper: background citation

OPTImization of Medication by Transdisciplinary Assessment of Drug Treatment in Elderly Hospitalized Patients: Application of a Definitive Intervention by Physicians or Clinical Pharmacists

TypeinterventionalSponsorUniversity College CorkRan2023 to 2024Enrolled642ConditionsMultimorbidity, PolypharmacyArmsDefinitive multi-faceted intervention consisting of several components, Sham Intervention
3 · Its place in the literature

Who cites it

122 citing papers in PubMed, 16 syntheses or guidelines pooled it, 206 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Interventions for preventing falls in older people in care facilities.The Cochrane database of systematic reviews · 2025
    Pooled it
  6. Pooled it
  7. Pooled it
  8. Pooled it
  9. Pooled it
  10. Pooled it
  11. Pooled it
  12. Pooled it
  13. Pooled it
  14. Pooled it
  15. Pooled it
  16. Pooled it
  17. Trial
  18. Trial
  19. Trial
  20. Trial

62 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

45 authors at 9 institutions in 6 countries.

Manuel R BlumDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Bastiaan T G M SalleveltClinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
Anne SpinewineClinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Belgium.
Denis O'MahonySchool of Medicine, University College Cork, Cork, Republic of Ireland.
Elisavet MoutzouriDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Martin FellerDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Christine BaumgartnerDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Marie RoumetCTU Bern, University of Bern, Bern, Switzerland.
Katharina Tabea JungoInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Nathalie SchwabDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Lisa BretagneDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Shanthi BeglingerDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Carole E AubertDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Ingeborg WiltingClinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
Stefanie ThevelinClinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Belgium.
Kevin MurphyPharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Republic of Ireland.
Corlina J A HuibersDepartment of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
A Clara Drenth-van MaanenDepartment of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
Benoit BolandGeriatric Medicine Division, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Erin CrowleyPharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Republic of Ireland.
Anne EichenbergerInstitute of Hospital Pharmacy, Bern University Hospital, University of Bern, Bern, Switzerland.
Michiel MeulendijkDepartment of Information and Computing Sciences, Utrecht University, Utrecht, Netherlands.
Emma JenningsSchool of Medicine, University College Cork, Cork, Republic of Ireland.
Luise AdamDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Marvin J RoosDepartment of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
Laura GleesonPharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Republic of Ireland.
Zhengru ShenDepartment of Information and Computing Sciences, Utrecht University, Utrecht, Netherlands.
Sophie MarienGeriatric Medicine Division, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Arend-Jan MeindersDepartment of Internal Medicine and Intensive Care Unit, St Antonius Hospital, Nieuwegein and Utrecht, Netherlands.
Oliver BaretellaDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Seraina NetzerDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Maria de MontmollinDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Anne FournierClinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Belgium.
Ariane MouzonDepartment of Pharmacy, CHU UCL Namur, Yvoir, Belgium.
Cian O'MahonyPharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Republic of Ireland.
Drahomir AujeskyDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Dimitris MavridisDepartment of Primary School Education, University of Ioannina, Greece.
Stephen ByrnePharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Republic of Ireland.
Paul A F JansenClinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
Matthias SchwenkglenksInstitute of Pharmaceutical Medicine, University of Basel, Basel, Switzerland.
Marco SpruitDepartment of Information and Computing Sciences, Utrecht University, Utrecht, Netherlands.
Olivia DalleurClinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Belgium.
Wilma KnolDepartment of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
Sven TrelleCTU Bern, University of Bern, Bern, Switzerland.
Nicolas RodondiDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland nicolas.rodondi@insel.ch.ORCID 0000-0001-9083-6896
University of Bern · CHUtrecht University · NLUniversity College Cork · IECliniques Universitaires Saint-Luc · BECHU Dinant Godinne UCL Namur · BEUCLouvain · BESt. Antonius Ziekenhuis · NLUniversity of Basel · CHUniversity of Ioannina · GR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo examine the effect of optimising drug treatment on drug related hospital admissions in older adults with multimorbidity and polypharmacy admitted to hospital.

designCluster randomised controlled trial.

setting110 clusters of inpatient wards within university based hospitals in four European countries (Switzerland, Netherlands, Belgium, and Republic of Ireland) defined by attending hospital doctors.

participants2008 older adults (≥70 years) with multimorbidity (≥3 chronic conditions) and polypharmacy (≥5 drugs used long term).

interventionClinical staff clusters were randomised to usual care or a structured pharmacotherapy optimisation intervention performed at the individual level jointly by a doctor and a pharmacist, with the support of a clinical decision software system deploying the screening tool of older person's prescriptions and screening tool to alert to the right treatment (STOPP/START) criteria to identify potentially inappropriate prescribing.

main outcome measurePrimary outcome was first drug related hospital admission within 12 months.

results2008 older adults (median nine drugs) were randomised and enrolled in 54 intervention clusters (963 participants) and 56 control clusters (1045 participants) receiving usual care. In the intervention arm, 86.1% of participants (n=789) had inappropriate prescribing, with a mean of 2.75 (SD 2.24) STOPP/START recommendations for each participant. 62.2% (n=491) had ≥1 recommendation successfully implemented at two months, predominantly discontinuation of potentially inappropriate drugs. In the intervention group, 211 participants (21.9%) experienced a first drug related hospital admission compared with 234 (22.4%) in the control group. In the intention-to-treat analysis censored for death as competing event (n=375, 18.7%), the hazard ratio for first drug related hospital admission was 0.95 (95% confidence interval 0.77 to 1.17). In the per protocol analysis, the hazard ratio for a drug related hospital admission was 0.91 (0.69 to 1.19). The hazard ratio for first fall was 0.96 (0.79 to 1.15; 237

conclusionsInappropriate prescribing was common in older adults with multimorbidity and polypharmacy admitted to hospital and was reduced through an intervention to optimise pharmacotherapy, but without effect on drug related hospital admissions. Additional efforts are needed to identify pharmacotherapy optimisation interventions that reduce inappropriate prescribing and improve patient outcomes.

trial registrationClinicalTrials.gov NCT02986425.

Indexed as

MultimorbidityPolypharmacyAccidental FallsAgedAged, 80 and overCluster AnalysisEuropeHospitalizationHumansInappropriate Prescribing

Identifiers

PMID34257088
PMCPMC8276068
OpenAlexW3181572830

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.