Comparison of the OPERAM DRA Adjudication Guide and AT-HARM10 to identify drug-related hospital admissions in older adults
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- Drug-related admissions (DRAs) are hospital admissions resulting from non-preventable adverse drug events or preventable medication errors and contribute to up to 30% of all admissions in older people. Detecting reasons for hospitalizations in older patients is complex because of their polypharmacy and multimorbidity. Two methods to screen for and adjudicate DRAs caused by adverse reaction, overuse, underuse and misuse of medication were elaborated and validated. While a multidisciplinary panel of experts uses the OPERAM method, AT-HARM10 is intended to be a faster implicit screening tool using 10 questions that could be used by pharmacy students. A comparison of adjudication outcome performed independently by an expert panel using the OPERAM method and students using AT-HARM10 was made on 376 hospitalizations in two hospitals. First outcome was the degree of agreement between methods on DRA detection using Cohen’s kappa. Secondary aims were (1) to determine proportions of DRAs detected by each method, (2) to categorize discrepancies between the users about assessment and about top five of medication classes (ATC3 level), (3) to evaluate adjudication time and training time needed with AT-HARM10 and (4) to determine performance of AT-HARM10 (OPERAM experts as gold standard).