Discussion
fractures, multimorbidity
EVENTS, SECONDARY
In this cluster randomised clinical trial evaluating the effect of a structured medication review intervention supported by an electronic decision support system in older adults with multimorbidity and polypharmacy, 58.5% of patients had at least one prescribing recommendation implemented. Despite the implementation of one STOPP or START recommendation per patient on average, the results on the appropriateness of medication and the number of prescribing omissions at the 12 month follow-up compared with usual care were inconclusive, with odds ratios for the MAI and the AOU being close to one and confidence intervals being wide. However, the intervention could be safely delivered without causing harm to patients. The results on whether the medication review intervention led to an improvement in the secondary outcomes, such as the number of falls and fractures, were also inconclusive. We emphasise that given the age characteristics and the comorbidities of the study population, not all falls and fractures can be assumed to be an (adverse) effect of polypharmacy despite older adults with polypharmacy being at a higher risk for such events.