Structured Pharmaceutical Analysis of the Systematic Tool to Reduce Inappropriate Prescribing Is an Effective Method for Final‐Year Medical Students to Improve Polypharmacy Skills: A Randomized Controlled Trial

Abstract

Medical students may not be adequately trained to prescribe appropriately to older adults with polypharmacy. This study addressed how to teach students to minimize inappropriate polypharmacy. Final-year medical students (N = 106) from two Dutch schools of medicine participated in this randomized controlled trial with a pre/posttest design. The Systematic Tool to Reduce Inappropriate Prescribing (STRIP) was used as the intervention. This medication review tool consists of five steps and is part of the Dutch multidisciplinary guideline on polypharmacy. Step two is a structured pharmaceutical analysis of drug use, assessed using six questions regarding undertreatment, ineffective treatment, overtreatment, potential adverse effects, contraindications or interactions, and dose adjustments. It is used in combination with the Screening Tool to Alert doctors to Right Treatment and the Screening Tool of Older Person's Prescriptions checklists. Students were asked to optimize the medication lists of real people, making use, or not, of the STRIP. The number of correct or potentially harmful decisions that the students made when revising the lists was determined by comparison with expert consensus. Students who used the STRIP had better scores than control students; they made more correct decisions (9.3 vs 7.0, 34%; P < .001, correlation coefficient (r) = 0.365) and fewer potentially harmful decisions (3.9 vs 5.6, -30%; P < .001, r = 0.386). E-learning did not have a different effect from that of non-E-learning methods. Students were satisfied with the method. The STRIP method is effective in helping final-year medical students improve their prescribing skills.

Clinical medication reviews in elderly patients with polypharmacy: a cross-sectional study on drug-related problems in the Netherlands

“…CMRs were conducted by community pharmacists who completed a medication review training accredited by the Royal Dutch Pharmacists Association. Pharmacists followed a method that evolved into the STRIP method [ 29 ]. Each CMR started with a semi-structured interview with the patient.…”

A pilot survey of junior doctors’ attitudes and awareness around medication review: time to change our educational approach?

“…However, reviewing and stopping medicines do not appear to be part of the culture of routine practice and generally not part of the admitting (junior) doctor's process. There is evidence that at the early stages of a medical career, doctors may not possess sufficient competence and confidence to perform a medication review, 6 and may feel uncomfortable stopping medicines that more senior doctors have initiated; indicative perhaps of hierarchical dominance. Research is needed to explore the ability and attitudes of junior doctors in contributing to medication review, as well as their awareness of medication review tools that have been developed to aid them in this process.…”

The Systematic Tool to Reduce Inappropriate Prescribing (STRIP): Combining implicit and explicit prescribing tools to improve appropriate prescribing

“…Previous studies have shown that medical students lack the knowledge and skills needed to prescribe appropriately for patients on polypharmacy. A multicentre randomized controlled trial was performed to investigate whether the STRIP improves the medication review skills of final‐year medical students . For practical reasons, it was not possible to study the entire STRIP, so the second step of the STRIP (pharmacotherapy review) was studied.…”

“…A multicentre randomized controlled trial was performed to investigate whether the STRIP improves the medication review skills of final-year medical students. 24 For practical reasons, it was not possible to study the entire STRIP, so the second step of the STRIP (pharmacotherapy review) was studied. In total, 106 final-year medical students from 2 Dutch universities were asked to optimize the medication lists of case histories, making use, or not, of the STRIP.…”