Medication optimisation in hospitalised older people with polypharmacy and multimorbidity

Abstract

Obtaining information about the patient's medication history and actual medication use while understanding wishes, experiences and beliefs about medications; Pharmacotherapy analysis:Identifying potential drug-related problems (e.g. underuse, overuse, misuse, potential adverse drug reactions, drug-drug interactions, drug-disease interactions, practical intake issues);3. Pharmaceutical care plan: Agreeing about therapeutic aims between the physician and pharmacist and how these aims could be achieved; 20 CHAPTER 1 Objectives of this thesisThe general aim of this thesis is to investigate strategies for medication optimisation in hospitalised older people with polypharmacy and multimorbidity. This aim was divided into the following objectives:1. To evaluate the applicability of medication optimisation tools recommended by clinical practice guidelines;2. To develop a process for in-hospital medication review using implicit and explicit medication optimisation tools; 3. To investigate the effect of an in-hospital medication review in older people with multimorbidity and polypharmacy on clinical outcomes; 4. To evaluate the process of the in-hospital medication review to formulate recommendations for future refinement of the medication review process. 24CHAPTER 1 References 1. SIMPATHY-consortium. Polypharmacy Management by 2030: a patient safety challenge 2017. https://ec.europa.eu/chafea/health/newsroom/news/documents/polypharmacyhandbook-second-edition_en.pdf (accessed May 30, 2022). 2. World Health Organization. WHO global patient safety challenge: medication without harm. 2017. 3.