Supervisor View Full Details 2nd

• Other

Prescribing optimization in older people

• Medicine

• Geriatric Medicine
• Pharmacology

The research programme has, since 2006, focused on prescribing in multi-morbid older people in hospital, in primary care and in the nursing home setting. Our group has developed the STOPP/START criteria for potentially inappropriate medications (PIM's - STOPP criteria) and potential prescribing omissions (PPO's - START criteria).

STOPP/START criteria are now in their second iteration (published 2014). STOPP/START criteria as an intervention have been shown to be beneficial in 4 RCTs, i.e.
(i) improving medication appropriateness (Gallagher P et al., 2011)
(ii) Reducing the incidence of major polypharmacy and falls (Frankenthal D et al., 2014)
(iii) Reducing medication costs (Frankenthal D et al., 2014, O'Connor M et al., 2016)
(iv) Reducing adverse drug reaction (ADR) incidence in acutely ill older people in hospital. (O'Connor M et al., 2016)
RCTs (i) and (iv) were undertaken and completed by our group in UCC.

We are currently co-ordinating an EU-funded (FP7) multi-centre RCT called SENATOR (www.senator-project.eu). The RCT involves randomizing acutely ill multi-morbid older patients with polypharmacy to normal pharmaceutical care (control arm) or to SENATOR software scrutiny of current medications plus normal pharmaceutical care (intervention arm), with the aim of determining if SENATOR software reduces the rate of incident ADRs in hospital.

Our research programme focuses on a variety of innovative methods for optimizing pharmacotherapy in older people with multi-morbidity with the aim of improving patient outcomes and getting better value for money. Research is focused on avoidance of PIMs and PPOs, minimizing ADRs and healthcare utilization resulting from drug adversity and avoidance of resource wastage relating to pharmacotherapy. The research programme is a collaboration between the UCC Department of Medicine (Geriatrics) and School of Pharmacy and involves close interdisciplinary physician/pharmacist interaction.

Increasingly, our research is focused on deprescribing i.e. the avoidance of pharmacotherapy that is not appropriate for reasons of non-indication, poor survival prognosis, excessive cost, unacceptable side-effects or poor adherence. New explicit criteria to assist the process of deprescribing in frail older people with survival prognosis likely less than 1 year have been developed recently by our group and have been validated by a multidisciplinary panel of experts. It is intended to examine the clinical and economic efficacy of these criteria by means of a randomized controlled trial.

The SENATOR software, currently being examined in secondary care, will need to be examined in primary care in terms of efficacy. SENATOR software may prove to have efficacy in secondary care, but its role and application primary care remains unknown. Another body of work is planned in which the acceptability to GPs and the efficacy of SENATOR software in primary care is to be examined.