Effects of a clinical medication review focused on personal goals, quality of life, and health problems in older persons with polypharmacy: A randomised controlled trial (DREAMeR-study)

Verdoorn, Sanne; Kwint, Henk-Frans; Blom, Jeanet W.; Gussekloo, Jacobijn; Bouvy, Marcel L.

doi:10.1371/journal.pmed.1002798

Cited by 89 publications

(131 citation statements)

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“…29 The EQ-VAS captures health more broadly than the dimensions included in the EQ-5D-5L 29 and has diverged from EQ-5D-5L index score in a previous trial of medication reviews in older adults. 38 strengths and limitations To our knowledge, this is the first study examining the role of practice-based pharmacists in Ireland and the feasibility of evaluating this role. We used a range of valid indicators of high-risk and potentially inappropriate prescribing to guide pharmacists' interventions and to measure the potential clinical benefits.…”

Section: Open Accessmentioning

confidence: 99%

Evaluation of the General Practice Pharmacist (GPP) intervention to optimise prescribing in Irish primary care: a non-randomised pilot study

et al. 2020

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ObjectiveLimited evidence suggests integration of pharmacists into the general practice team could improve medicines management for patients, particularly those with multimorbidity and polypharmacy. This study aimed to develop and assess the feasibility of an intervention involving pharmacists, working within general practices, to optimise prescribing in Ireland.DesignNon-randomised pilot study.SettingPrimary care in Ireland.ParticipantsFour general practices, purposively sampled and recruited to reflect a range of practice sizes and demographic profiles.InterventionA pharmacist joined the practice team for 6 months (10 hours/week) and undertook medication reviews (face to face or chart based) for adult patients, provided prescribing advice, supported clinical audits and facilitated practice-based education.Outcome measuresAnonymised practice-level medication (eg, medication changes) and cost data were collected. Patient-reported outcome measure (PROM) data were collected on a subset of older adults (aged ≥65 years) with polypharmacy using patient questionnaires, before and 6 weeks after medication review by the pharmacist.ResultsAcross four practices, 786 patients were identified as having 1521 prescribing issues by the pharmacists. Issues relating to deprescribing medications were addressed most often by the prescriber (59.8%), compared with cost-related issues (5.8%). Medication changes made during the study equated to approximately €57 000 in cost savings assuming they persisted for 12 months. Ninety-six patients aged ≥65 years with polypharmacy were recruited from the four practices for PROM data collection and 64 (66.7%) were followed up. There were no changes in patients’ treatment burden or attitudes to deprescribing following medication review, and there were conflicting changes in patients’ self-reported quality of life.ConclusionsThis non-randomised pilot study demonstrated that an intervention involving pharmacists, working within general practices is feasible to implement and has potential to improve prescribing quality. This study provides rationale to conduct a randomised controlled trial to evaluate the clinical and cost-effectiveness of this intervention.

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Section: Open Accessmentioning

confidence: 99%

Evaluation of the General Practice Pharmacist (GPP) intervention to optimise prescribing in Irish primary care: a non-randomised pilot study

et al. 2020

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“…The average healthcare costs of the patients in this study are representative of the current Dutch situation for this age group 42 . A CMR could lead to small cost savings in healthcare compared to usual care and an average reduction of 0.5 in the number of drugs in use after 6 months 32 . Although the variation for each cost category was high in both groups, the results are strengthened by the sensitivity analyses, which show that the analysis is robust to variations in variables.…”

Section: Discussionmentioning

confidence: 90%

“…Effects on primary outcomes are presented in Table 3 and extensively described in another paper 32 . Mean QALYs measured with EQ‐5D per 6 months were 0.369 (0.355–0.377) and 0.367 (0.345–0.370) for respectively the control group and intervention group, resulting in an incremental QALY of −0.00217.…”

Section: Resultsmentioning

confidence: 96%

Cost‐utility and cost‐effectiveness analysis of a clinical medication review focused on personal goals in older persons with polypharmacy compared to usual care: Economic evaluation of the DREAMeR study

Verdoorn

Pol

Hövels

et al. 2020

Brit J Clinical Pharma

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Aims The ageing society may lead to increasing healthcare expenditure. A clinical medication review (CMR) could potentially reduce costs. The aim of this study is to perform a cost‐utility and cost‐effectiveness analysis from a societal perspective of a patient‐centred CMR. Methods A trial‐based cost‐utility and cost‐effectiveness analysis was performed as part of the DREAMeR study, a pragmatic controlled trial that randomised patients aged ≥70 years using at least seven drugs to either CMR or usual care. Over six months, healthcare consumption and drug use were collected to estimate costs, and effects were collected in terms of quality‐adjusted life years (QALYs) measured with EQ‐5D‐5 L and EQ‐VAS and as reduced health‐related complaints with impact on patients' daily lives. Results The total mean costs per patient (n = 588) over six months were €4,189 ± 6,596 for the control group (n = 294) and €4,008 ± 6,678 for the intervention group (n = 294), including estimated intervention costs of €199 ± 67, which resulted in a mean incremental total cost savings of €181 for the intervention group compared to the control group. Compared to the control group, for the intervention group, the mean incremental QALYs over six months were: −0.00217 measured with EQ‐5D and 0.003 measured with EQ‐VAS. The incremental effect of reduced health‐related complaints with impact was −0.34. There was a likelihood of >90% that the intervention was cost‐saving. Conclusions The benefits of a patient‐centred CMR were inconsistent with no benefits on HR‐QoL measured with EQ‐5D‐5 L and small benefits on HR‐QoL measured with EQ‐VAS and health‐related complaints with impact on patients' daily lives. Additionally, a CMR could potentially be cost saving from a societal perspective.

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“…For subgroups based on patient characteristics, seven studies for frail patients were included. 37 - 43 The group can be further divided into patients in care homes or home-dwelling. 37 - 43 The three studies investigating the effect of medication review delivered to elderly people in care homes demonstrate that medication reviews can identify DRP, generate solutions in collaboration with other health professionals and facilitate deprescribing of inappropriate medication.…”

Section: Resultsmentioning

confidence: 99%

“…reported no significant differences for economic outcomes from 314 control- and 364 intervention patients. 40 , 43 …”

Section: Resultsmentioning

confidence: 99%

For which patient subgroups does exist positive outcomes from a medication review? A systematic review

Abrahamsen

Hansen

Rossing

2020

Pharm Pract (Granada)

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Background: A medication review is a possibility to assess and optimise a patient’s medicine. A model that includes a medication review and a follow-up seem to provide the best results. However, it is not known whether specific subgroups of patients benefit more from a medication review than others. Objective: This literature review summarises the evidence that is available on which patient subgroups exist positive outcomes from a medication review carried out in a primary care setting. Methods: We performed a PICO analysis to identify keywords for setting, medication review and effect. We then conducted a search using the PubMed database (2004 to 2019) to identify studies relevant for our investigation. A screening process was carried out based on either title or abstract, and any study that matched the aim and inclusion criteria was included. All matching studies were obtained and read, and were included if they met predefined criteria such as study design, medication review and primary care. The studies were divided into subgroups. First, each subgroup was divided according to the studies’ own definition. Secondly, each subgroup was allocated as either risk patients if the subgroup described a specific patient subgroup or risk medication, if the subgroup was defined as using a specific type of medication. This was done after discussion in the author group. Results: 28 studies from a total of 935 studies were included. Identified studies were divided into either risk patients; frail, recently discharged or multimorbid patients, or risk medication; heart medication, antithrombotic medication, blood pressure lowering medication, antidiabetic medication, anti-Parkinson medication or medication increasing the risk of falls. The subgroups identified from a medication review in primary care were defined as being frail, recently discharged from hospital or multimorbid (risk patients), or defined as patients using anticoagulant or blood pressure lowering medication (risk medication). Most of the medication reviews in the studies that showed an economic effect included at least one follow-up and were delivered by a pharmacist. Conclusions: The literature review demonstrates that medication reviews delivered by pharmacists to specific subgroups of patients are a way of optimising the economic effect of medication reviews in primary care. This is obtained by reducing health-related costs or the number of contacts with primary or secondary health care services.

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Effects of a clinical medication review focused on personal goals, quality of life, and health problems in older persons with polypharmacy: A randomised controlled trial (DREAMeR-study)

Cited by 89 publications

References 50 publications

Evaluation of the General Practice Pharmacist (GPP) intervention to optimise prescribing in Irish primary care: a non-randomised pilot study

Evaluation of the General Practice Pharmacist (GPP) intervention to optimise prescribing in Irish primary care: a non-randomised pilot study

Cost‐utility and cost‐effectiveness analysis of a clinical medication review focused on personal goals in older persons with polypharmacy compared to usual care: Economic evaluation of the DREAMeR study

For which patient subgroups does exist positive outcomes from a medication review? A systematic review

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