Opti-Med: the effectiveness of optimised clinical medication reviews in older people with ‘geriatric giants’ in general practice; study protocol of a cluster randomised controlled trial

Willeboordse, Floor; Hugtenburg, Jacqueline G.; Dijk, Liset van; Bosmans, Judith E.; Vries, Oscar J. de; Schellevis, François G.; Elders, Petra

doi:10.1186/1471-2318-14-116

Cited by 14 publications

(18 citation statements)

References 53 publications

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“…Also, in noncardiovascular patients most RCTs with an overall medication review as the single intervention showed a positive effect on the number of DRPs . Although the mean number of drugs used by the intervention patients in these studies is comparable to our study (range 6–10 drugs/patient), the mean number of potential DRPs (range 4.4–8.6 potential DRPs/patient) and the mean number of actual DRPs/proposals for intervention per patient (range 1–6 per patient) reported in these studies with noncardiovascular patients were generally higher . There are several possible explanations for this difference in findings.…”

Section: Discussionsupporting

confidence: 49%

Effectiveness of medication review on the number of drug‐related problems in patients visiting the outpatient cardiology clinic: A randomized controlled trial

Huiskes

Ende

Kruijtbosch

et al. 2019

Brit J Clinical Pharma

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Aims:To assess the effectiveness of medication review on the number of drugrelated problems (DRPs) in outpatient cardiology patients. Methods:In this randomized controlled trial, a computer-assisted and pharmacist-led medication review with patient involvement (questionnaire and telephone call with pharmacist) was conducted in intervention patients prior to their visit to the cardiologist. The control group received usual care. Adult outpatient cardiology patients without support concerning the administration of medication, without a medication review in the past 6 months and who gave permission to access their electronic medication record were included. The primary outcome measure was the number of DRPs 1 month after the visit. Secondary outcome measures concerned the type of DRP and the type of medication involved in the DRPs. Results:In total, 75 patients (mean [standard deviation, SD] age 66.0 [12.5] years, 41% female) were included. Intervention (n = 90) and control group (n = 85) were comparable at baseline. The mean (SD) number of drugs used per patient was 7.9 (3.9). After 1 month, the mean (SD) number of DRPs was 0.3 (0.7) and 0.8 (1.0) and the median (range) number of DRPs was 0 (0-4) and 0 (0-4) in the intervention group and control group, respectively (P < .001). In the intervention group, 74% of the DRPs identified at T0 were solved at T1 vs 14% in the control group. Conclusion: This randomized controlled trial suggests that a pharmacist-led medication review in patients with a scheduled visit to the outpatient cardiology clinic decreases the number of DRPs. K E Y W O R D S clinical pharmacology, drug development, drug safety, drug utilization, prescribing, quality use of medicines, randomised controlled trial PI statement: The authors confirm that the Principal Investigator for this paper is Bartholomeus Johannes Fredericus van den Bemt. Acquisition of data: H.T.E., M.M. and V.M.M.M.Statistical analysis an interpretation of data:

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Section: Discussionsupporting

confidence: 49%

Effectiveness of medication review on the number of drug‐related problems in patients visiting the outpatient cardiology clinic: A randomized controlled trial

Huiskes

Ende

Kruijtbosch

et al. 2019

Brit J Clinical Pharma

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“…Other studies concerning improving appropriate prescription in (mostly older) patients receiving complex polypharmacy present a more time-consuming algorithm or method than usual care [ 26 ]. The time aspect might be a strength of our approach in comparison to other ongoing studies [ 14 , 15 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…Based on other studies [ 24 ], measurements of EQ-5D-3 L might even enable an economic evaluation of the danger of adverse drug reactions.…”

Section: Discussionmentioning

confidence: 99%

Effect of a patient-centered drug review on polypharmacy in primary care patients: study protocol for a cluster-randomized controlled trial

Hasler

Senn

Rosemann

et al. 2015

Trials

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BackgroundManaging patients with polypharmacy is a challenging issue in primary care. The aim of this study is to determine whether a patient-centered systematic review leads to more appropriate medication use in patients without negatively affecting quality of life and the course of the disease.Methods/Design The trial is a two-armed, double blinded cluster-randomized controlled trial. Primary care physicians (PCPs) will be randomly assigned to the intervention or control group. Physicians in the intervention group undergo training with instruction of the algorithm. The control group is given a lecture on multimorbidity and instructions for collecting data in a usual care manner.PCPs will approach patients aged 60 years or older who are taking 5 or more drugs. The study period is 1 year.The primary outcome measure is the change in the number of drugs 12 months after the algorithm was applied by the PCP during consultation with the patient. Secondary outcomes are: change in the number of drugs immediately after the encounter and 6 months later, reason for a change of the medication, discrepancy in the decision to change between PCP and patient, number of drugs for which the patient is suggesting a change, number of drugs the patient is taking that are not known to the PCP, time consumption of the intervention, disease-specific variables to evaluate the course of the disease(s) for which the patient is being treated , quality of life, barriers against using the algorithm, numbers of drugs readopted due to an unfavorable course of the disease, and numbers of drugs which have been started.DiscussionAnswering the four questions of the algorithm requires a weighing-up of risks and benefits and contains a shared-decision-making approach: a prioritization of the treatment goals is necessary. This can only be done in collaboration with the patient. The majority of patients with multimorbidity are treated in the primary care setting. This underlines the significance of our study carried out in this setting: given the high prevalence of adverse drug events in patients with multimorbidity an intervention like ours has a large potential to reduce drug-related morbidity.Trial registrationISRCTN16560559 13 November 2014

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“…The Dutch guideline for polypharmacy in older patients recommends face-to-face interviews, however this is very time-consuming. [ 14 , 15 ], Patient involvement in medication reviews is desirable and may improve patient outcomes, but as yet is not evidence-based and might not be needed at all times and costs [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Information on actual medication use and drug-related problems in older patients: questionnaire or interview?

et al. 2016

Self Cite

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Background Information on medication use and drug-related problems is important in the preparation of clinical medication reviews. Critical information can only be provided by patients themselves, but interviewing patients is time-consuming. Alternatively, patient information could be obtained with a questionnaire. Objective In this study the agreement between patient information on medication use and drug-related problems in older patients obtained with a questionnaire was compared with information obtained during an interview. Setting General practice in The Netherlands. Method A questionnaire was developed to obtain information on actual medication use and drug-related problems. Two patient groups C65 years were selected based on general practitioner electronic medical records in nine practices; I. polypharmacy and II. C1 predefined general geriatric problems. Eligible patients were asked to complete the questionnaire and were interviewed afterwards. Main outcome measure Agreement on information on medication use and drug-related problems collected with the questionnaire and interview was calculated. Results Ninety-seven patients participated. Of all medications used, 87.6 % (95 % CI 84.7-90.5) was reported identically in the questionnaire and interview. Agreement for the complete medication list was found for 45.4 % (95 % CI 35.8-55.3) of the patients. On drug-related problem level, agreement between questionnaire and interview was 75 %. Agreement tended to be lower in vulnerable patients characterized by C4 chronic diseases, C10 medications used and low health literacy. Conclusion Information from a questionnaire showed reasonable agreement compared with interviewing. The patients reported more medications and drug-related problems in the interview than the questionnaire. Taking the limitations into account, a questionnaire seems a suitable tool for medication reviews that may replace an interview for most patients.

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Opti-Med: the effectiveness of optimised clinical medication reviews in older people with ‘geriatric giants’ in general practice; study protocol of a cluster randomised controlled trial

Cited by 14 publications

References 53 publications

Effectiveness of medication review on the number of drug‐related problems in patients visiting the outpatient cardiology clinic: A randomized controlled trial

Effectiveness of medication review on the number of drug‐related problems in patients visiting the outpatient cardiology clinic: A randomized controlled trial

Effect of a patient-centered drug review on polypharmacy in primary care patients: study protocol for a cluster-randomized controlled trial

Information on actual medication use and drug-related problems in older patients: questionnaire or interview?

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