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Older people have the highest prevalence rates of polypharmacy, inappropriate prescribing and adverse drug reactions (ADRs) with associated high levels of morbidity [Permpongkosol, 2011; Scott and Jayathissa, 2010]. Studies from several European countries consistently show about 6% of all hospital admissions in adults can be directly attributed to ADRs [Pirmohamed, 2004; Franceschi et al. 2008; Hamilton et al. 2011]. Another large study in the Netherlands calculated that €94 million (0.5%) of the country’s total hospital budget was spent on medication-related admissions [Leendertse et al. 2011]. The cost for the UK was estimated around €706 million in 2004 [Pirmohamed et al. 2004] and €434 million in Germany in 2006 [Rottenkolber et al. 2011]. There is wide agreement that the best strategy to prevent ADR-related morbidity is to focus on high-risk groups such as older people with polypharmacy [Leendertse et al. 2011; Dequito et al. 2011]. Demand for geriatricians and other specialists in this field far outweigh supply, so the prospect of easy-to-use software to guide clinicians has tremendous potential to improve patient care. However, a major challenge is that any software solutions would need to safely handle the complexity that characterizes this patient group. A recent review concluded that there are no validated, reliable, widely used prevention strategies in older people [Petrovic et al. 2012]. Although there are a number of well-known existing tools such as the STOPP-START criteria [O’Mahony et al. 2015] and Beers criteria [American Geriatrics Society 2015 Beers Criteria Update Expert Panel, 2015], they are usually limited to use in research and are not easily applied in routine clinical practice due to the volume of information and multiple rules that apply [Caslake et al. 2013]. Some interventions provide a structured format for the review of prescribed medication, but either rely on the clinician’s considerable specialist clinical pharmacology knowledge in older people or involve applying one of the above tools [e.g. the systematic tool to reduce inappropriate prescribing (STRIP)] [Keisjers et al. 2014]. A number of Computerized Provider Order Entry (CPOE) systems are in use for electronic prescribing, but none are specially designed for older people and, though partly effective, they rely mostly on warning clinicians only about drug–drug interactions [Schiff et al. 2015]. Moreover, another potentially important strategy to avoid ADRs involves maximizing use of evidence-based nonpharmacological therapies but none of the above tools address this. Therefore, there was a clear need to develop and validate a new and more sophisticated tool that could address this important gap. Here, we describe the efforts made to date by our group to develop and test a new software engine for the optimization of medical and nondrug therapy in older people with multimorbidity and polypharmacy (SENATOR).

therapeutic advances in drug safety

The SENATOR project: developing and trialling a novel software engine to optimize medications and nonpharmacological therapy in older people with multimorbidity and polypharmacy