• Luise Adam, Elisavet Moutzouri, Christine Baumgartner, Axel Lennart Loewe, Martin Feller, Khadija M'Rabet-Bensalah, Nathalie Schwab, Stefanie Hossmann, Claudio Schneider, Sabrina Jegerlehner, Carmen Floriani, Andreas Limacher, Katharina Tabea Jungo, Corlina Johanna Alida Huibers, Sven Streit, Matthias Schwenkglenks, Marco Spruit, Anette Van Dorland, Jacques Donzé, Patricia M Kearney, Peter Jüni, Drahomir Aujesky, Paul Jansen, Benoit Boland, Olivia Dalleur, Stephen Byrne, Wilma Knol, Anne Spinewine, Denis O'Mahony, Sven Trelle, and Nicolas Rodondi.
• Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
• BMJ Open. 2019 Jun 3; 9 (6): e026769.

IntroductionMultimorbidity and polypharmacy are important risk factors for drug-related hospital admissions (DRAs). DRAs are often linked to prescribing problems (overprescribing and underprescribing), as well as non-adherence with drug regimens for different reasons. In this trial, we aim to assess whether a structured medication review compared with standard care can reduce DRAs in multimorbid older patients with polypharmacy.Methods And AnalysisOPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people is a European multicentre, cluster randomised, controlled trial. Hospitalised patients ≥70 years with ≥3 chronic medical conditions and concurrent use of ≥5 chronic medications are included in the four participating study centres of Bern (Switzerland), Utrecht (The Netherlands), Brussels (Belgium) and Cork (Ireland). Patients treated by the same prescribing physician constitute a cluster, and clusters are randomised 1:1 to either standard care or Systematic Tool to Reduce Inappropriate Prescribing (STRIP) intervention with the help of a clinical decision support system, the STRIP Assistant. STRIP is a structured method performing customised medication reviews, based on Screening Tool of Older People's Prescriptions/Screening  Tool to Alert to Right Treatment criteria to detect potentially inappropriate prescribing. The primary endpoint is any DRA where the main reason or a contributory reason for the patient's admission is caused by overtreatment or undertreatment, and/or inappropriate treatment. Secondary endpoints include number of any hospitalisations, all-cause mortality, number of falls, quality of life, degree of polypharmacy, activities of daily living, patient's drug compliance, the number of significant drug-drug interactions, drug overuse and underuse and potentially inappropriate medication.Ethics And DisseminationThe local Ethics Committees in Switzerland, Ireland, The Netherlands and Belgium approved this trial protocol. We will publish the results of this trial in a peer-reviewed journal.Main FundingEuropean Union's Horizon 2020 programme.Trial Registration NumberNCT02986425 , SNCTP000002183 , NTR6012, U1111-1181-9400.© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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