SENATOR

SENATOR

Software ENgine for the Assessment & optimization of drug and non-drug Therapy in Older peRsons

Background

Multimorbidity, i.e. multiple simultaneous medical conditions, increases steadily in prevalence beyond the age of 70 years. As the European population ages, the number of older people with multimorbidity will inevitably increase in tandem. Multimorbidity, is a strong predictor of multiple medications, so-called polypharmacy (PP), which is recognized as the single greatest risk factor for adverse drug reactions (ADRs) and prescribing of potentially inappropriate medications (PIMs). The incidence of serious ADRs is increasing steadily with the rising proportion of older patients with multimorbidity in the community, such that ADRs are now recognized a serious public health problem globally, with very serious implications for health budgets in ageing societies. The problem of ADRs is particularly problematic in the hospital environment, where approximately one in four older people are affected by an ADR at admission; 6% of older person acute admissions to hospital result directly from ADRs, and a further 6% - 21% of older people experience new ADRs during hospitalization with acute illness. Together with the high rates of over-use and inappropriate use of drug therapy in these older patients, under-use of non-drug therapies (physiotherapy, occupational therapy, speech & language therapy, nutritional therapy etc) is increasingly recognized. Despite this, there are no clear-cut guidelines or methodologies for optimizing pharmacological and non- pharmacological therapy in older people. Given that the great majority of older people with multimorbidity will be managed by clinicians who are not specially trained in Geriatric Medicine & Rehabilitation, it is not reasonable to expect these clinicians to provide specialist-standard clinical care of older people with multimorbidity. Rather, valid and effective methods are needed for assisting clinicians who are not specialized in Geriatric Medicine & Rehabilitation to optimize pharmacological and non- pharmacological therapy in the expanding multimorbid older population.

The Project

The central aims of this study are to:

  1. Develop a highly-powered and efficient software engine (SENATOR) capable of individually screening the clinical status and pharmacological and non- pharmacological therapy of older people with multimorbidity in order to define optimal drug therapy, highlight ADR risk, indicate best value drug brand for selection and provide advice on appropriate non-pharmacological therapy.
  2.  Perform a multi-centre randomized controlled clinical trial (RCT) in older people with multimorbidity admitted to hospital with acute unselected illness under the care of specialists other than geriatricians to examine the efficacy of SENATOR in reducing ADRs, inappropriate prescribing and healthcare costs in this age group. The RCT will also examine, as a proof-of-concept exercise, whether SENATOR's non-pharmacological therapy optimization advice prompts the clinician to refer patients in the intervention arm for appropriate non-pharmacological therapies compared to control patients receiving standard care.
  3.  Assess the cost-effectiveness of SENATOR-guided optimization of drug and non-drug therapy compared to standard care in older hospitalized people.
  4.  Develop SENATOR as a commercial software product for the healthcare software market, if the previous work can show that SENATOR (a) improves clinical outcomes in older people and (b) reduces overall healthcare costs. 

Timeline

The SENATOR project is funded as an FP7 project from 2013 through to 2017.

Pillars Targeted

SENATOR targets the first pillar, prevention,screening, & early diagnosis and the specific action A1, treatment adherence starting with a prescription and adherence action.

Funding

Funding provisionally approved: 5.938 Million Euro over 60 months.

References

Barry PJ, O'Keefe N, O'Connor KA, O'Mahony D. Inappropriate prescribing in the elderly: a comparison of the Beers criteria and the improved prescribing in the elderly tool (IPET) in acutely ill elderly hospitalized patients. J Clin Pharm Ther. 2006 Dec;31(6):617-26.

Gallagher P, Barry P, O'Mahony D. Inappropriate prescribing in the elderly. J Clin Pharm Ther. 2007 Apr;32(2):113-21.

O'Mahony D, Gallagher PF. Inappropriate prescribing in the older population: need for new criteria. Age Ageing. 2008 Mar;37(2):138-41.

Gallagher P and O'Mahony D. STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers'criteria. Age Ageing (2008) 37 (6): 673-679.

Gallagher P, Ryan C, Byrne S, Kennedy J, O'Mahony D. STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008 Feb;46(2):72-83.

Hamilton HJ, Gallagher PF, O'Mahony D. Inappropriate prescribing and adverse drug events in older people. BMC Geriatr. 2009 Jan 28;9:5. 

Ryan C, O'Mahony D, Kennedy J, Weedle P, Barry P, Gallagher P, Byrne S. Appropriate prescribing in the elderly: an investigation of two screening tools, Beers criteria considering diagnosis and independent of diagnosis and improved prescribing in the elderly tool to identify inappropriate use of medicines in the elderly in primary care in Ireland. J Clin Pharm Ther. 2009 Aug;34(4):369-76. 

Ryan C, O'Mahony D, Kennedy J, Weedle P, Byrne S. Potentially inappropriate prescribing in an Irish elderly population in primary care. Br J Clin Pharmacol. 2009 Dec;68(6):936-47. O'Mahony D, O'Connor M N. Pharmacotherapy at the end-of-life. Age Ageing (2011) 40 (4): 419-422. 

O'Connor M N, Gallagher P, Byrne S, O'Mahony D. Adverse drug reactions in older patients during hospitalisation: are they predictable? Age Ageing (2012)doi: 10.1093/ageing/afs046. 

O'Connor MN, Gallagher P, O'Mahony D. Drugs Aging. Inappropriate prescribing: criteria, detection and prevention. 2012 Jun 1;29(6):437-52.

CHARGE-UCC

Centre for Gerontology and Rehabilitation , School of Medicine, UCC The Bungalow, Block 13, St. Finbarr's Hospital, Douglas Rd., Cork, Ireland

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