Abstract
ObjectivesRecruiting general practitioners (GPs) and their multimorbid older patients for trials is challenging for multiple reasons (e.g., high workload, limited mobility). The comparability of study participants is important for interpreting study findings. This manuscript describes the baseline characteristics of GPs and patients participating in the ‘Optimizing PharmacoTherapy in older multimorbid adults In primary CAre’ (OPTICA) trial, a study of optimization of pharmacotherapy for multimorbid older adults. The overall aim of this study was to determine if the GPs and patients participating in the OPTICA trial are comparable to the real-world population in Swiss primary care.DesignAnalysis of baseline data from GPs and patients in the OPTICA trial and a reference cohort from the FIRE (‘Family medicine ICPC Research using Electronic medical records’) project.SettingPrimary care, Switzerland.ParticipantsThree hundred twenty-three multimorbid (≥ 3 chronic conditions) patients with polypharmacy (≥ 5 regular medications) aged ≥ 65 years and 43 GPs recruited for the OPTICA trial were compared to 22,907 older multimorbid patients with polypharmacy and 227 GPs from the FIRE database.MethodsWe compared the characteristics of GPs and patients participating in the OPTICA trial with other GPs and other older multimorbid adults with polypharmacy in the FIRE database. We described the baseline willingness to have medications deprescribed of the patients participating in the OPTICA trial using the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire.ResultsThe GPs in the FIRE project and OPTICA were similar in terms of sociodemographic characteristics and their work as a GP (e.g. aged in their fifties, ≥ 10 years of experience, ≥ 60% are self-employed, ≥ 80% work in a group practice). The median age of patients in the OPTICA trial was 77 years and 45% of trial participants were women. Patients participating in the OPTICA trial and patients in the FIRE database were comparable in terms of age, certain clinical characteristics (e.g. systolic blood pressure, body mass index) and health services use (e.g. selected lab and vital data measurements). More than 80% of older multimorbid patients reported to be willing to stop ≥ 1 of their medications if their doctor said that this would be possible.ConclusionThe characteristics of patients and GPs recruited into the OPTICA trial are relatively comparable to characteristics of a real-world Swiss population, which indicates that recruiting a generalizable patient sample is possible in the primary care setting. Multimorbid patients in the OPTICA trial reported a high willingness to have medications deprescribed.Trial registrationClinicaltrials.gov (NCT03724539), KOFAM (Swiss national portal) (SNCTP000003060), Universal Trial Number (U1111-1226-8013)
Highlights
The population group of adults aged ≥ 65 years is growing faster than all other age groups combined
The characteristics of patients and General practitioner (GP) recruited into the older multimorbid patients In primary CAre’ (OPTICA) trial are relatively comparable to characteristics of a real-world Swiss population, which indicates that recruiting a generalizable patient sample is possible in the primary care setting
What types of GPs participated in the OPTICA trial, and how did they compare to the non‐participating GPs from FIRE? As shown in Table 2, GPs who participated in OPTICA and those from the FIRE reference cohort were in their fifties on average (OPTICA median = 54, FIRE median = 51), had several years of experience working as a GPs (OPTICA median = 15, FIRE median = 10), and the majority were self-employed (OPTICA self-employed = 70%, FIRE selfemployed = 63%)
Summary
The population group of adults aged ≥ 65 years is growing faster than all other age groups combined. Multimorbid patients often use multiple medications and with polypharmacy comes a higher risk of using potentially inappropriate medications (PIMs). PIMs are medications for which the risk of potential adverse events outweighs the clinical benefits, such as when there are more effective and safer alternatives available for use in older adults [2]. The use of PIMs is associated with increased risk of adverse drug events, falls and cognitive impairment [3,4,5,6]. The use of potentially inappropriate medications is high in this patient group [8] In this context, the ‘Optimizing PharmacoTherapy in older multimorbid adults In primary CAre’ (OPTICA) trial was launched with the aim of investigating whether an electronic clinical decision support tool can help GPs to optimise medication use of older multimorbid patients with polypharmacy
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