Less Is More: Optimized Pharmacotherapy With Improved coNtinuity of CarE in hospitaLized oLder peOple

The goal of this cluster randomized controlled trial is to compare transitional multidisciplinary pharmacotherapeutic care (TMPC) with usual care in patients aged 70 years or older with polypharmacy, admitted to the hospital via the emergency department for longer than 24 hours and that have an elevated risk of drug related readmissions. The primary aims of the study are: * To assess whether TMPC leads to a decrease in number of DRreAs compared to usual care during the first 30 days after index hospitalisation. * To assess whether TMPC is cost-effective Participants will receive TMPC in hospitals allocated to the intervention. TMPC will be executed by a pharmacotherapeutic team, it consists of the following four elements: * pharmacotherapeutic analysis * transitional multidisciplinary discussion * pharmacotherapeutic care interview and discussion with the patient * discharge note with the pharmacotherapeutic care plan Researchers will compare TMPC with usual care to assess the effect and cost-effectiveness of TMPC.

Inclusion Criteria: * 70 years or older * Polypharmacy, the use of 5 or more regular medications, defined as authorised medications with registration numbers, used for more than 30 days. Topical preparations are excluded from this definition. * Admitted to hospital through the ED (which comprises both the general emergency department and the cardiac emergency department) * Length of hospitalisation more than 24 hours * Completed medication verification * DRA prediction percentage of 23.0% or higher Exclusion Criteria: * No informed consent by patient or a legal representative * Participation in an interfering clinical trial * Elective hospital admission * Direct admission to the ICU (when medication verification as usual can't be executed, and therefore inclusion of patients as described in 10.2 is not possible) * A life expectancy of less than 3 months, which includes patients with palliative treatment at home, direct admission to palliative care or palliative care planned within 24 hours after index hospital admission. * Patient or legal representative not able to speak Dutch. * Follow-up of patient primarily by secondary caregivers. This refers to situations where the secondary caregiver is in the lead of the medication list of the patient instead of the GP or elderly care physician, for example in the following patient groups: * patients receiving intensive oncologic therapy * patients in an organ- or stem cell transplantation procedure * patients receiving intensive (chronic) psychiatric care, such as patients admitted to a medical psychiatric unit * patients on dialysis