Implications of findings
multimorbidity
The STRIPA web based tool was not integrated into the electronic health record software programs used by general practitioners, which could explain the challenges in implementation. The future widespread and successful use of eCDSS in primary care settings requires that limitations, such as the lack of integration of eCDSS into existing practice software and clinical workflows, must be overcome. Furthermore, in Swiss primary care settings, it will be crucial to establish an industry standard that will allow reliable exports/imports of data from electronic health record software to eCDSS, which was also one of the main challenges observed during the OPTICA trial and led to an increased expenditure of time by general practitioners who had to update the data manually in the eCDSS.Future trials on interventions to optimise medication would benefit from interventions focusing on overcoming challenges to implementation. This not only requires preparatory qualitative studies to better understand the challenges but also use of implementation science strategies to integrate interventions into clinical workflows, tailoring interventions to users’ needs, and piloting interventions. Future interventions may benefit from being designed as repeated interventions to accommodate the dynamic prescribing practices and frequent medication changes in older patients with multimorbidity and polypharmacy.