Abstract
BackgroundClinical medication reviews (CMR) are increasingly performed in older patients with polypharmacy. Studies have shown positive effects of CMR on process- and intermediate outcomes, like drug-related problems (DRPs). Little effect has been shown on clinical outcomes, like hospital admissions or health-related quality of life (HR-QoL). In particular, HR-QoL is related to the individual health-related goals and complaints of patients. The aim of this study is to investigate the effects of a CMR focused on personal goals on HR-QoL and health-related complaints in older patients with polypharmacy.MethodsA randomised controlled trial will be performed in 35 Dutch community pharmacies aiming to include 630 patients aged 70 years and older using seven or more chronic drugs. Patients will be randomly assigned to control or intervention group by block-randomisation per pharmacy. Patients in the intervention group receive a CMR focused on patients’ preferences, personal goals and health-related complaints. With every goal a goal attainment scale (GAS) will be proposed. Primary outcome measures are HR-QoL, measured with the EQ-5D-5L and EQ-VAS and the number of health-related complaints per patient measured with a written questionnaire, during a follow-up period of six months. Secondary outcomes are healthcare utilisation, number and type of drug changes, number and type of health-related goals, scores on GAS and number and type of DRPs and interventions.DiscussionThis study is expected to add evidence on the effects of a CMR on HR-QoL and health-related complaints in older patients with polypharmacy. New in this study is the use of personal goals measured with GAS and health-related complaints as patient-related outcome measures.Trial registrationNetherlands Trial Register; NTR5713.
Highlights
Clinical medication reviews (CMR) are increasingly performed in older patients with polypharmacy
Evaluation After 2-4 weeks Score +2 +1 0 -1 -2 -3 time spent by the pharmacist is calculated by the average time writing per CMR for every pharmacy
All pharmacists will be asked to record the time spent for every step of the medication review process; including patient interview, Drug Related Problems (DRP) analysis, conversation with general practitioner (GP) and follow-up and monitoring
Summary
Clinical medication reviews (CMR) are increasingly performed in older patients with polypharmacy. Studies have shown positive effects of CMR on process- and intermediate outcomes, like drug-related problems (DRPs). Little effect has been shown on clinical outcomes, like hospital admissions or health-related quality of life (HR-QoL). The aim of this study is to investigate the effects of a CMR focused on personal goals on HR-QoL and health-related complaints in older patients with polypharmacy. Little effect has been shown on major clinical outcomes, like morbidity, mortality, hospital admissions and health-related quality of life (HR-QoL) [6, 8, 20, 22,23,24,25]. One study has shown that medication review with follow-up service improves HR-QoL and is likely to be cost-effective [26].
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