Impact of the Goal‐directed Medication Review Electronic Decision Support System on Drug Burden Index: A cluster‐randomised clinical trial in primary care

Abstract

Aims The Goal‐directed Medication Review Electronic Decision Support System (G‐MEDSS) assesses and reports a patient's goals, attitudes to deprescribing and Drug Burden Index (DBI) score, a measure of cumulative exposure to anticholinergic and sedative medications. This study evaluated the effect of implementing G‐MEDSS in home medicines reviews (HMRs) on DBI exposure and clinical outcomes. Methods A cluster‐randomised clinical trial was performed across Australia. Accredited clinical pharmacists were randomised into intervention (G‐MEDSS with usual care HMR) or comparison groups (usual care HMR alone). Patients were recruited by pharmacists from those routinely referred by general practitioners for HMR. The primary outcome was the proportion of patients with any reduction in DBI at 3‐months follow‐up. Secondary outcomes included change in DBI continuous score at 3‐months, HMR recommendations to change DBI and clinical outcomes. Results There were 201 patient participants at baseline (n = 88 intervention, n = 113 comparison), with 159 followed‐up at 3‐months (n = 63 intervention, n = 96 comparison). The proportion of patients with a reduction in DBI was not significantly different at 3‐months (intervention 17%, comparison 11%; adjusted odds ratio 1.44, 95% confidence interval 0.56–3.80). Regarding secondary outcomes, there was no difference in change in DBI score at 3‐months. However, the HMR report made recommendations to reduce DBI for a significantly greater proportion of patients in the intervention than in the comparison group (intervention 37%, comparison 14%; adjusted odds ratio 3.20, 95% confidence interval 1.50–6.90). No changes were observed in clinical outcomes. Conclusion Implementation of G‐MEDSS within HMR did not reduce patients' DBI at 3 months compared with usual care HMR.

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

“…In their trial, the appropriateness of prescription was evaluated by pharmacists reviewing the documentation previously prepared by clinical assistants, unlike our study, in which the evaluators were family physicians with clinical experience and training in polypharmacy who had the medical history of each patient available to them, which could have influenced the MAI score. The baseline MAI score found in MULTIPAP is similar to that of other studies, which have had baseline MAI scores of approximately 14 points [ 15 , 17 , 38 , 43 , 44 , 45 , 46 , 47 ].…”

Medication reviews and deprescribing as a single intervention in falls prevention: a systematic review and meta-analysis

“…Eleven of the included studies were individually randomised [ 24–34 ], and eight studies were cluster-randomised [ 35–42 ]. Eight of the studies were conducted in the United States [ 24 , 28–30 , 33 , 35 , 38 , 40 ], eight in Europe [ 25–27 , 31 , 37 , 41 , 42 ] and two in Australia [ 36 , 39 ] and one in New Zealand [ 32 ]. The sample size ranged from 81 to 3,904 participants, and the mean age between 67 and 85 years.…”

Willingness of older people living with dementia and mild cognitive impairment and their caregivers to have medications deprescribed

“…Results of the rPATDcog may be used to inform deprescribing discussions, leading to more meaningful shared decision-making [ 35–37 ]. Our findings provide insight into key points to be included in educational interventions and one-on-one conversations.…”