How to Improve Healthcare for Patients with Multimorbidity and Polypharmacy in Primary Care: A Pragmatic Cluster-Randomized Clinical Trial of the MULTIPAP Intervention

Abstract

(1) Purpose: To investigate a complex MULTIPAP intervention that implements the Ariadne principles in a primary care population of young-elderly patients with multimorbidity and polypharmacy and to evaluate its effectiveness for improving the appropriateness of prescriptions. (2) Methods: A pragmatic cluster-randomized clinical trial was conducted involving 38 family practices in Spain. Patients aged 65–74 years with multimorbidity and polypharmacy were recruited. Family physicians (FPs) were randomly allocated to continue usual care or to provide the MULTIPAP intervention based on the Ariadne principles with two components: FP training (eMULTIPAP) and FP patient interviews. The primary outcome was the appropriateness of prescribing, measured as the between-group difference in the mean Medication Appropriateness Index (MAI) score change from the baseline to the 6-month follow-up. The secondary outcomes were quality of life (EQ-5D-5 L), patient perceptions of shared decision making (collaboRATE), use of health services, treatment adherence, and incidence of drug adverse events (all at 1 year), using multi-level regression models, with FP as a random effect. (3) Results: We recruited 117 FPs and 593 of their patients. In the intention-to-treat analysis, the between-group difference for the mean MAI score change after a 6-month follow-up was −2.42 (95% CI from −4.27 to −0.59) and, between baseline and a 12-month follow-up was −3.40 (95% CI from −5.45 to −1.34). There were no significant differences in any other secondary outcomes. (4) Conclusions: The MULTIPAP intervention improved medication appropriateness sustainably over the follow-up time. The small magnitude of the effect, however, advises caution in the interpretation of the results given the paucity of evidence for the clinical benefit of the observed change in the MAI. Trial registration: Clinicaltrials.gov NCT02866799.

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“…Based on the findings of this study, patient safety in PC should be a priority for politicians, health managers, and clinicians. In this sense, the implementation of the following measures could be useful: electronic prescription aids to warn before the occurrence of errors [ 29 , 30 ], interventions aimed at facilitating communication with the patient concerning their treatment [ 27 , 28 ], warning systems for critical results in diagnostic tests, improving the diagnostic process (checklist, support systems for clinical decision, etc. ), and better follow-up procedures (reminders, patients for patient safety, etc.).…”

Older Persons’ and Health Care Professionals’ Design Choices When Co-Designing a Medication Plan Aiming to Promote Patient Safety: Case Study

“…International guidelines targeting multimorbidity and polypharmacy in older people highlight the value of a joint plan for continued treatment, that is, a "medication plan" for both older people and health care professionals to facilitate safer medication treatment [15]. Moreover, an agreement between older persons who use medications and health care professionals on health-related goals for treatment may benefit all those involved and prevent harm [16][17][18]. In a similar spirit, Sweden has a national program for the implementation of "Patient Contracts" [19,20], an agreement regarding the patient's planned health care, created collaboratively, documented in the electronic health record (EHR), and intended to strengthen the relationship between a patient and health care professionals.…”

Recent Updates on Risk and Management Plans Associated with Polypharmacy in Older Population

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