Development and application of measurement methods focusing on medication related problems in elderly hospitalised patients

In conclusion, elderly hospitalised patients form a patient group that is at higher risk for medication related problems compared to younger patients. In order to measure medication related problems in hospitalised elderly and to ultimately improve their pharmaceutical care we examined three possible levels of measurement one can choose. These three levels of focus (systems, process, and outcome level) were practiced in three measurement methods. As a starting point in an improvement trajectory a systems approach using the prospective risk analysis method with the Bow-Tie model is recommended. For periodical quality of care measurement and less resource intensive research it is best to use explicit process measures like our QIs (or the original ACOVE QIs). For research in which resources and time are not scarce and measuring actual patient harm is of importance, the ADE measurement method of our WINGS study is the best choice. Whereas explicit process measures, like our indicators, facilitate comparison of results of other studies using the same or comparable indicators, results of studies reporting ADEs should be compared with utmost caution. Based on the results from all three measurement methods in this thesis it can, however, be concluded that the quality of pharmaceutical care for elderly patients is still poor and needs improvement.