Medicines Optimisation Clinical Trial
Official title:
Development of the Medicines Optimisation Assessment Tool (MOAT) - Targeting Hospital Pharmacists' Input to Reduce Risks and Improve Patient Outcomes
The purpose of this study is to develop a prediction-tool, the Medicines Optimisation Assessment Tool (MOAT), to assist hospital pharmacists identify patients at highest risk of preventable medication related problems (MRPs). This has the potential to permit pharmacists to identify and focus on the small number of patients (approximately 6%) who are likely to experience a significant MRP while in hospital.
The purpose of this study is to develop a prediction-tool, the Medicines Optimisation
Assessment Tool (MOAT), to assist hospital pharmacists identify patients at highest risk of
preventable medication related problems (MRPs).
The MOAT will be developed following recommendations of the PROGnosis RESearch Strategy
(PROGRESS) partnership. A prospective cohort study of 1,500 patients will be used to develop
the MOAT from the medical wards of two UK hospitals. Data will be collected on prognostic
factors (selected based on a review of published literature and expert opinion) for each
patient, together with details of MRPs that occur. All MRPs will be reviewed by an expert
panel who will grade for severity and preventability using recognised criteria. Multivariable
logistic regression models will be used to determine the relationship between potential risk
factors such as polypharmacy, renal impairment, and the use of 'high risk' medicines, and the
study outcome of preventable medication related problems that are at least moderate in
severity. Bootstrapping will be used to adjust the MOAT for optimism, and predictive
performance will be assessed using calibration and discrimination. A simplified scoring
system will also be developed, which will be assessed for sensitivity and specificity.
The intention of this research is to develop a prediction-tool (the MOAT), which has the
potential to be adopted widely into clinical practice. If the initial research is successful
in producing a prediction-tool with good predictive performance further research will be
carried out to assess how feasible it would be to use the MOAT in practice, the potential
efficiency savings, and an assessment of clinical risk to patients through use of the MOAT.
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