Abstract
BackgroundMultimorbid patients receiving polypharmacy represent a growing population at high risk for negative health outcomes. Tailoring is an approach of systematic intervention development taking account of previously identified determinants of practice. The aim of this study was to assess the effect of a tailored program to improve the implementation of three important processes of care for this patient group: (a) structured medication counseling including brown bag reviews, (b) the use of medication lists, and (c) structured medication reviews to reduce potentially inappropriate medication.MethodsWe conducted a cluster-randomized controlled trial with a follow-up time of 9 months. Participants were general practitioners (GPs) organized in quality circles and participating in a GP-centered care contract of a German health insurance. Patients aged >50 years, suffering from at least 3 chronic diseases, receiving more than 4 drugs, and being at high risk for medication-related events according to the assessment of the treating GP were enrolled. The tailored program consisted of a workshop for GPs and health care assistants, educational materials and reminders for patients, and the elaboration of implementation action plans. The primary outcome was the change in the degree of implementation between baseline and follow-up, measured by a summary score of 10 indicators. The indicators were based on structured surveys with patients and GPs.ResultsWe analyzed the data of 21 GPs (10 - intervention group, 11 - control group) and 273 patients (130 - intervention group, 143 - control group). The increase in the degree of implementation was 4.2 percentage points (95% confidence interval: −0.3, 8.6) higher in the intervention group compared to the control group (p = 0.1). Two of the 10 indicators were significantly improved in the intervention group: medication counseling (p = 0.017) and brown bag review (p = 0.012). Secondary outcomes showed an effect on patients’ self-reported use of medication lists when buying drugs in the pharmacy (p = 0.03).ConclusionsThe tailored program may improve implementation of medication counseling and brown bag review whereas the use of medication lists and medication reviews did not improve. No effect of the tailored program on the combined primary outcome could be substantiated. Due to limitations of the study, results have to be interpreted carefully. The factors facilitating and hindering successful implementation will be examined in a comprehensive process evaluation.Trial registration numberISRCTN34664024, assigned 14/08/2013
Highlights
Multimorbid patients receiving polypharmacy represent a growing population at high risk for negative health outcomes
Twenty-four General practitioner (GP) of 20 practices organized in 11 different Quality circles (QC) agreed to participate
This study examined the effect of a tailored program on the primary and secondary outcomes, which reflected the degree of implementation of three recommendations for patients with multimorbidity and polypharmacy
Summary
Multimorbid patients receiving polypharmacy represent a growing population at high risk for negative health outcomes. Deficiencies in the care of multimorbid patients with polypharmacy Patients suffering from multiple chronic conditions and being treated with polypharmacy (commonly defined as permanent intake of more than four drugs) [1] represent a constantly growing population [2] at high risk for preventable adverse drug reactions (ADR) [3], potentially avoidable hospital admissions [4] and preventable deaths [5]. Prescribing and monitoring errors are common in primary and hospital care They may lead to a potentially inappropriate medication (PIM), which can be determined by implicit criteria, such as the Medication Appropriateness Index (MAI) [9] and explicit criteria, such as the PRISCUS list, a German adaption of the Beers criteria [10]. Patients taking PIM are at higher risk for ADR [14] and hospital admission [15]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
