Information and communications technology support for medication review in nursing home residents : Update of the OptiMEDs tool and an evaluation of the improvement of the new version

Abstract: Background: In older age polypharmacy is common due to a higher rate of chronic diseases. Taking multiple medications can result in drug related problems resulting in higher health care costs. OptiMEDs is an information and communications technology (ICT) guided medication review program that was created to improve the quality of the prescription of medicines in elderly. A pilot study of OptiMEDs was performed in 3 nursing homes in Belgium during 2019-2020.  Aim: To update the explicit criteria behind OptiMEDs and to make the tool more specific.  Method: Through a literature search of explicit criteria of potentially inappropriate prescribing (PIM-lists), newer versions published between 1st of January 2018 – 31st of October 2022 were sought. Redundancy of alerts was reduced by removing all the double alerts of PIMs. To minimize the number of alerts issued by the tool, several approaches to exemptions from and exclusion to PIMs were tested. To evaluate the improvement, results from the previous and new rule base were compared using the same dataset from the OptiMEDs feasibility trial.  Results:OnlyonePIM-list(Beer’scriteria)hadanewversion,resultingin45PIMsbeingadded to the database and 33 PIMs were removed. Removal of the duplicates resulted in a database with 594 PIMs. With the OptiMEDs data set; The amount of patients having a PIM decreased with 25.1 % when removing EU(7)-list as a source. The amount of patient having at least one candidate for deprescribing decreased with 10.4 % when only keeping the deprescribing.org and RTCs as a source.  Conclusion: The update probably made OptiMEDs more user-friendly as the number of PIMs decreased and the number of medications candidated for deprescribing decreased. However, an important further update is still needed, which is to include the clinical-based PIMs.