Multidisciplinary medication therapy management and participant responses to recommendations: Results from the INCREASE trial

Abstract

AbstractBackgroundMedication use, especially in the context of polypharmacy and inappropriate medications, may be a modifiable risk factor for cognitive impairment and dementia. Medication therapy management (MTM) interventions, which seek to optimize patient‐specific medication regimens, may restore cognitive function and delay onset of cognitive decline. Here, we describe an MTM protocol, delivering patient‐centered recommendations through joint decision‐making among the study participant, pharmacy specialist, and non‐pharmacist clinician (e.g., study physician) directed at delaying the symptomatic onset and progression of AD.MethodCommunity dwelling adults age 65 and older, without dementia, using at least one potentially inappropriate medication (PIM) were enrolled in a clinical trial to evaluate the effect of the MTM on improving medication appropriateness and cognition (INCREASE; NCT08245639). In a three‐step process, study pharmacists first identified potential mediation‐related problems (MRPs) and made initial recommendations for prescribed and over‐the‐counter medications, vitamins, and supplements. Second, study team clinicians and pharmacists reviewed all initial recommendations together with the participants, allowing for revisions to make a final recommendation. Third, participant responses to final recommendations were recorded. Here, we evaluated participant responses in relation to medication class and type of final recommendation.ResultAmong the 90 randomized participants, a mean 6.7±3.6 MRPs per participant were reported. A total of 259 initial MTM recommendations were made for the treatment group participants, with 40% percent undergoing revision in the second step (Table 1). Participants reported willingness to adopt 46% of final recommendations and need for additional primary care input in response to 38% of final recommendations. Willingness to adopt final recommendations was highest when therapeutic switches were offered and/or with anticholinergic medications (Table 1).ConclusionAs integration of healthcare disciplines and specialized services become an increasingly important part of collaborative healthcare practices, this study demonstrated that initial MTM recommendations often change through group discussion, and multidisciplinary decision‐making that incorporated the preferences of patients themselves often led to positive participant responses. Further studies are needed to assess whether participants adhere to MTM recommendations long‐term, and to evaluate the health and economic impact of MTM on chronic disease prevention and maintenance, such as with AD and related dementias.