Randomized controlled trial of an intervention to improve drug appropriateness in communitydwelling polymedicated elderly people

Lluís Campins, Mateu Serra-Prat, Inés Gózalo, David López, Elisabet Palomera, Clara Agustí, Mateu Cabré, Aizpurua Miren Maite, Alegre Maria, Armada Antònia, Azhara Sánchez, Bancells Mireia, Barbena Eugènia, Bartolomé Maria, Bosch Montserrat, Buxadé Isaac, Calvo Marta, Camps Marcella, Casabella Dolors, Casanova Toni & 71 others Casas Gemma, Castellanos Rosa, Castro Salvador, Chaves Berta, Cid Sílvia, Coma Rosa M, Corona Enric, Domenech Joan, Es Eva Imma, Fabré Esther, Fabregas Xavier, Flores Pere, Font Isabel, Garcia Consol, Garcia Vanesa, Gonzalez Teté, Gozalo Inés, Gros Teresa, Gurrera Teresa, Hinojosa Gregorio, Jerez Núria, Jiménez Mercè, Jiménez Tamara, Juanola Josep, Jurado Lucia, Limon Esther, Lledonet Pere, Lloret Jordi, Lloret Jordi, Lloret Montse, Lopez Ainhoa, Luna Carolina, Mahramci Mozgham, Marta Vanessa, Martí Juan José, Martí Oriol, Martínez Dolors, Martínez Miquel Àngel, Massot Mireia, Mateu Laura, Mengual Núria, Menjón Nacho, Mir Mar, Montero Juan Carlos, Montero Pilar, Morales Susana Nuñez Josep, Ana M Palacio, Palomera Mercè, Papiol Mònica, Pascual Joan, Pató Lourdes, Robusté Miquel, Roca Ingrid, Roces Ana, Roger Mel, Salabarnada Jordi, Samaniego Fernando, Sánchez Dolors, Sanz Elisa, Serra Miriam, Serra Pere, Serrano Cristina, Skiffter Dorte, Soler Clara, Son Pelin, Sorribes Josep, Toran Pere, Torrellas Eulàlia, Tria Carles, Verde Yolanda, Villarroya Isabel

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background. Polypharmacy is frequent in the elderly population and is associated with potentially drug inappropriateness and drug-related problems. Objectives. To assess the effectiveness and safety of a medication evaluation programme for community-dwelling polymedicated elderly people. Design. Randomized, open-label, multicentre, parallel-arm clinical trial with 1-year follow-up. Setting. Primary care centres. Participants. Polymedicated (≥8 drugs) elderly people (≥70 years). Study intervention. Pharmacist review of all medication according to the Good Palliative-Geriatric Practice algorithm and the Screening Tool of Older Person's Prescriptions-Screening Tool to Alert Doctors to the Right Treatment criteria and recommendations to the patient's physician. Control intervention. Routine clinical practice. Measurements. Recommendations and changes implemented, number of prescribed drugs, restarted drugs, primary care and emergency department consultations, hospitalizations and death. Results. About 503 (252 intervention and 251 control) patients were recruited and 2709 drugs were evaluated. About 26.5% of prescriptions were rated as potentially inappropriate and 21.5% were changed (9.1% discontinuation, 6.9% dose adjustment, 3.2% substitution and 2.2% new prescription). About 2.62 recommendations per patient were made and at least one recommendation was made for 95.6% of patients. The mean number of prescriptions per patient was significantly lower in the intervention group at 3- and 6-month follow-up. Discontinuations, dose adjustments and substitutions were significantly higher than in the control group at 3, 6 and 12 months. No differences were observed in the number of emergency visits, hospitalizations and deaths. Conclusion. The study intervention was safe, reduced potentially inappropriate medication, but did not reduce emergency visits and hospitalizations in polymedicated elderly people.

Original languageEnglish (US)
Pages (from-to)36-42
Number of pages7
JournalFamily Practice
Volume34
Issue number1
DOIs
StatePublished - 2017

Fingerprint

Randomized Controlled Trials
Prescriptions
Pharmaceutical Preparations
Hospitalization
Primary Health Care
Emergencies
Independent Living
Polypharmacy
Program Evaluation
Patient Rights
Pharmacists
Geriatrics
Hospital Emergency Service
Referral and Consultation
Clinical Trials
Physicians
Safety
Control Groups
Population

Keywords

  • Ageing
  • Multidisciplinary care
  • Pharmacology/drug reactions
  • Primary care
  • Public health
  • Quality of care

ASJC Scopus subject areas

  • Family Practice

Cite this

Campins, L., Serra-Prat, M., Gózalo, I., López, D., Palomera, E., Agustí, C., ... Isabel, V. (2017). Randomized controlled trial of an intervention to improve drug appropriateness in communitydwelling polymedicated elderly people. Family Practice, 34(1), 36-42. https://doi.org/10.1093/fampra/cmw073

Randomized controlled trial of an intervention to improve drug appropriateness in communitydwelling polymedicated elderly people. / Campins, Lluís; Serra-Prat, Mateu; Gózalo, Inés; López, David; Palomera, Elisabet; Agustí, Clara; Cabré, Mateu; Maite, Aizpurua Miren; Maria, Alegre; Antònia, Armada; Sánchez, Azhara; Mireia, Bancells; Eugènia, Barbena; Maria, Bartolomé; Montserrat, Bosch; Isaac, Buxadé; Marta, Calvo; Marcella, Camps; Dolors, Casabella; Toni, Casanova; Gemma, Casas; Rosa, Castellanos; Salvador, Castro; Berta, Chaves; Sílvia, Cid; M, Coma Rosa; Enric, Corona; Joan, Domenech; Imma, Es Eva; Esther, Fabré; Xavier, Fabregas; Pere, Flores; Isabel, Font; Consol, Garcia; Vanesa, Garcia; Teté, Gonzalez; Inés, Gozalo; Teresa, Gros; Teresa, Gurrera; Gregorio, Hinojosa; Núria, Jerez; Mercè, Jiménez; Tamara, Jiménez; Josep, Juanola; Lucia, Jurado; Esther, Limon; Pere, Lledonet; Jordi, Lloret; Jordi, Lloret; Montse, Lloret; Ainhoa, Lopez; Carolina, Luna; Mozgham, Mahramci; Vanessa, Marta; José, Martí Juan; Oriol, Martí; Dolors, Martínez; Àngel, Martínez Miquel; Mireia, Massot; Laura, Mateu; Núria, Mengual; Nacho, Menjón; Mar, Mir; Carlos, Montero Juan; Pilar, Montero; Josep, Morales Susana Nuñez; Palacio, Ana M; Mercè, Palomera; Mònica, Papiol; Joan, Pascual; Lourdes, Pató; Miquel, Robusté; Ingrid, Roca; Ana, Roces; Mel, Roger; Jordi, Salabarnada; Fernando, Samaniego; Dolors, Sánchez; Elisa, Sanz; Miriam, Serra; Pere, Serra; Cristina, Serrano; Dorte, Skiffter; Clara, Soler; Pelin, Son; Josep, Sorribes; Pere, Toran; Eulàlia, Torrellas; Carles, Tria; Yolanda, Verde; Isabel, Villarroya.

In: Family Practice, Vol. 34, No. 1, 2017, p. 36-42.

Research output: Contribution to journalArticle

Campins, L, Serra-Prat, M, Gózalo, I, López, D, Palomera, E, Agustí, C, Cabré, M, Maite, AM, Maria, A, Antònia, A, Sánchez, A, Mireia, B, Eugènia, B, Maria, B, Montserrat, B, Isaac, B, Marta, C, Marcella, C, Dolors, C, Toni, C, Gemma, C, Rosa, C, Salvador, C, Berta, C, Sílvia, C, M, CR, Enric, C, Joan, D, Imma, EE, Esther, F, Xavier, F, Pere, F, Isabel, F, Consol, G, Vanesa, G, Teté, G, Inés, G, Teresa, G, Teresa, G, Gregorio, H, Núria, J, Mercè, J, Tamara, J, Josep, J, Lucia, J, Esther, L, Pere, L, Jordi, L, Jordi, L, Montse, L, Ainhoa, L, Carolina, L, Mozgham, M, Vanessa, M, José, MJ, Oriol, M, Dolors, M, Àngel, MM, Mireia, M, Laura, M, Núria, M, Nacho, M, Mar, M, Carlos, MJ, Pilar, M, Josep, MSN, Palacio, AM, Mercè, P, Mònica, P, Joan, P, Lourdes, P, Miquel, R, Ingrid, R, Ana, R, Mel, R, Jordi, S, Fernando, S, Dolors, S, Elisa, S, Miriam, S, Pere, S, Cristina, S, Dorte, S, Clara, S, Pelin, S, Josep, S, Pere, T, Eulàlia, T, Carles, T, Yolanda, V & Isabel, V 2017, 'Randomized controlled trial of an intervention to improve drug appropriateness in communitydwelling polymedicated elderly people', Family Practice, vol. 34, no. 1, pp. 36-42. https://doi.org/10.1093/fampra/cmw073
Campins, Lluís ; Serra-Prat, Mateu ; Gózalo, Inés ; López, David ; Palomera, Elisabet ; Agustí, Clara ; Cabré, Mateu ; Maite, Aizpurua Miren ; Maria, Alegre ; Antònia, Armada ; Sánchez, Azhara ; Mireia, Bancells ; Eugènia, Barbena ; Maria, Bartolomé ; Montserrat, Bosch ; Isaac, Buxadé ; Marta, Calvo ; Marcella, Camps ; Dolors, Casabella ; Toni, Casanova ; Gemma, Casas ; Rosa, Castellanos ; Salvador, Castro ; Berta, Chaves ; Sílvia, Cid ; M, Coma Rosa ; Enric, Corona ; Joan, Domenech ; Imma, Es Eva ; Esther, Fabré ; Xavier, Fabregas ; Pere, Flores ; Isabel, Font ; Consol, Garcia ; Vanesa, Garcia ; Teté, Gonzalez ; Inés, Gozalo ; Teresa, Gros ; Teresa, Gurrera ; Gregorio, Hinojosa ; Núria, Jerez ; Mercè, Jiménez ; Tamara, Jiménez ; Josep, Juanola ; Lucia, Jurado ; Esther, Limon ; Pere, Lledonet ; Jordi, Lloret ; Jordi, Lloret ; Montse, Lloret ; Ainhoa, Lopez ; Carolina, Luna ; Mozgham, Mahramci ; Vanessa, Marta ; José, Martí Juan ; Oriol, Martí ; Dolors, Martínez ; Àngel, Martínez Miquel ; Mireia, Massot ; Laura, Mateu ; Núria, Mengual ; Nacho, Menjón ; Mar, Mir ; Carlos, Montero Juan ; Pilar, Montero ; Josep, Morales Susana Nuñez ; Palacio, Ana M ; Mercè, Palomera ; Mònica, Papiol ; Joan, Pascual ; Lourdes, Pató ; Miquel, Robusté ; Ingrid, Roca ; Ana, Roces ; Mel, Roger ; Jordi, Salabarnada ; Fernando, Samaniego ; Dolors, Sánchez ; Elisa, Sanz ; Miriam, Serra ; Pere, Serra ; Cristina, Serrano ; Dorte, Skiffter ; Clara, Soler ; Pelin, Son ; Josep, Sorribes ; Pere, Toran ; Eulàlia, Torrellas ; Carles, Tria ; Yolanda, Verde ; Isabel, Villarroya. / Randomized controlled trial of an intervention to improve drug appropriateness in communitydwelling polymedicated elderly people. In: Family Practice. 2017 ; Vol. 34, No. 1. pp. 36-42.
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abstract = "Background. Polypharmacy is frequent in the elderly population and is associated with potentially drug inappropriateness and drug-related problems. Objectives. To assess the effectiveness and safety of a medication evaluation programme for community-dwelling polymedicated elderly people. Design. Randomized, open-label, multicentre, parallel-arm clinical trial with 1-year follow-up. Setting. Primary care centres. Participants. Polymedicated (≥8 drugs) elderly people (≥70 years). Study intervention. Pharmacist review of all medication according to the Good Palliative-Geriatric Practice algorithm and the Screening Tool of Older Person's Prescriptions-Screening Tool to Alert Doctors to the Right Treatment criteria and recommendations to the patient's physician. Control intervention. Routine clinical practice. Measurements. Recommendations and changes implemented, number of prescribed drugs, restarted drugs, primary care and emergency department consultations, hospitalizations and death. Results. About 503 (252 intervention and 251 control) patients were recruited and 2709 drugs were evaluated. About 26.5{\%} of prescriptions were rated as potentially inappropriate and 21.5{\%} were changed (9.1{\%} discontinuation, 6.9{\%} dose adjustment, 3.2{\%} substitution and 2.2{\%} new prescription). About 2.62 recommendations per patient were made and at least one recommendation was made for 95.6{\%} of patients. The mean number of prescriptions per patient was significantly lower in the intervention group at 3- and 6-month follow-up. Discontinuations, dose adjustments and substitutions were significantly higher than in the control group at 3, 6 and 12 months. No differences were observed in the number of emergency visits, hospitalizations and deaths. Conclusion. The study intervention was safe, reduced potentially inappropriate medication, but did not reduce emergency visits and hospitalizations in polymedicated elderly people.",
keywords = "Ageing, Multidisciplinary care, Pharmacology/drug reactions, Primary care, Public health, Quality of care",
author = "Llu{\'i}s Campins and Mateu Serra-Prat and In{\'e}s G{\'o}zalo and David L{\'o}pez and Elisabet Palomera and Clara Agust{\'i} and Mateu Cabr{\'e} and Maite, {Aizpurua Miren} and Alegre Maria and Armada Ant{\`o}nia and Azhara S{\'a}nchez and Bancells Mireia and Barbena Eug{\`e}nia and Bartolom{\'e} Maria and Bosch Montserrat and Buxad{\'e} Isaac and Calvo Marta and Camps Marcella and Casabella Dolors and Casanova Toni and Casas Gemma and Castellanos Rosa and Castro Salvador and Chaves Berta and Cid S{\'i}lvia and M, {Coma Rosa} and Corona Enric and Domenech Joan and Imma, {Es Eva} and Fabr{\'e} Esther and Fabregas Xavier and Flores Pere and Font Isabel and Garcia Consol and Garcia Vanesa and Gonzalez Tet{\'e} and Gozalo In{\'e}s and Gros Teresa and Gurrera Teresa and Hinojosa Gregorio and Jerez N{\'u}ria and Jim{\'e}nez Merc{\`e} and Jim{\'e}nez Tamara and Juanola Josep and Jurado Lucia and Limon Esther and Lledonet Pere and Lloret Jordi and Lloret Jordi and Lloret Montse and Lopez Ainhoa and Luna Carolina and Mahramci Mozgham and Marta Vanessa and Jos{\'e}, {Mart{\'i} Juan} and Mart{\'i} Oriol and Mart{\'i}nez Dolors and {\`A}ngel, {Mart{\'i}nez Miquel} and Massot Mireia and Mateu Laura and Mengual N{\'u}ria and Menj{\'o}n Nacho and Mir Mar and Carlos, {Montero Juan} and Montero Pilar and Josep, {Morales Susana Nu{\~n}ez} and Palacio, {Ana M} and Palomera Merc{\`e} and Papiol M{\`o}nica and Pascual Joan and Pat{\'o} Lourdes and Robust{\'e} Miquel and Roca Ingrid and Roces Ana and Roger Mel and Salabarnada Jordi and Samaniego Fernando and S{\'a}nchez Dolors and Sanz Elisa and Serra Miriam and Serra Pere and Serrano Cristina and Skiffter Dorte and Soler Clara and Son Pelin and Sorribes Josep and Toran Pere and Torrellas Eul{\`a}lia and Tria Carles and Verde Yolanda and Villarroya Isabel",
year = "2017",
doi = "10.1093/fampra/cmw073",
language = "English (US)",
volume = "34",
pages = "36--42",
journal = "Family Practice",
issn = "0263-2136",
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TY - JOUR

T1 - Randomized controlled trial of an intervention to improve drug appropriateness in communitydwelling polymedicated elderly people

AU - Campins, Lluís

AU - Serra-Prat, Mateu

AU - Gózalo, Inés

AU - López, David

AU - Palomera, Elisabet

AU - Agustí, Clara

AU - Cabré, Mateu

AU - Maite, Aizpurua Miren

AU - Maria, Alegre

AU - Antònia, Armada

AU - Sánchez, Azhara

AU - Mireia, Bancells

AU - Eugènia, Barbena

AU - Maria, Bartolomé

AU - Montserrat, Bosch

AU - Isaac, Buxadé

AU - Marta, Calvo

AU - Marcella, Camps

AU - Dolors, Casabella

AU - Toni, Casanova

AU - Gemma, Casas

AU - Rosa, Castellanos

AU - Salvador, Castro

AU - Berta, Chaves

AU - Sílvia, Cid

AU - M, Coma Rosa

AU - Enric, Corona

AU - Joan, Domenech

AU - Imma, Es Eva

AU - Esther, Fabré

AU - Xavier, Fabregas

AU - Pere, Flores

AU - Isabel, Font

AU - Consol, Garcia

AU - Vanesa, Garcia

AU - Teté, Gonzalez

AU - Inés, Gozalo

AU - Teresa, Gros

AU - Teresa, Gurrera

AU - Gregorio, Hinojosa

AU - Núria, Jerez

AU - Mercè, Jiménez

AU - Tamara, Jiménez

AU - Josep, Juanola

AU - Lucia, Jurado

AU - Esther, Limon

AU - Pere, Lledonet

AU - Jordi, Lloret

AU - Jordi, Lloret

AU - Montse, Lloret

AU - Ainhoa, Lopez

AU - Carolina, Luna

AU - Mozgham, Mahramci

AU - Vanessa, Marta

AU - José, Martí Juan

AU - Oriol, Martí

AU - Dolors, Martínez

AU - Àngel, Martínez Miquel

AU - Mireia, Massot

AU - Laura, Mateu

AU - Núria, Mengual

AU - Nacho, Menjón

AU - Mar, Mir

AU - Carlos, Montero Juan

AU - Pilar, Montero

AU - Josep, Morales Susana Nuñez

AU - Palacio, Ana M

AU - Mercè, Palomera

AU - Mònica, Papiol

AU - Joan, Pascual

AU - Lourdes, Pató

AU - Miquel, Robusté

AU - Ingrid, Roca

AU - Ana, Roces

AU - Mel, Roger

AU - Jordi, Salabarnada

AU - Fernando, Samaniego

AU - Dolors, Sánchez

AU - Elisa, Sanz

AU - Miriam, Serra

AU - Pere, Serra

AU - Cristina, Serrano

AU - Dorte, Skiffter

AU - Clara, Soler

AU - Pelin, Son

AU - Josep, Sorribes

AU - Pere, Toran

AU - Eulàlia, Torrellas

AU - Carles, Tria

AU - Yolanda, Verde

AU - Isabel, Villarroya

PY - 2017

Y1 - 2017

N2 - Background. Polypharmacy is frequent in the elderly population and is associated with potentially drug inappropriateness and drug-related problems. Objectives. To assess the effectiveness and safety of a medication evaluation programme for community-dwelling polymedicated elderly people. Design. Randomized, open-label, multicentre, parallel-arm clinical trial with 1-year follow-up. Setting. Primary care centres. Participants. Polymedicated (≥8 drugs) elderly people (≥70 years). Study intervention. Pharmacist review of all medication according to the Good Palliative-Geriatric Practice algorithm and the Screening Tool of Older Person's Prescriptions-Screening Tool to Alert Doctors to the Right Treatment criteria and recommendations to the patient's physician. Control intervention. Routine clinical practice. Measurements. Recommendations and changes implemented, number of prescribed drugs, restarted drugs, primary care and emergency department consultations, hospitalizations and death. Results. About 503 (252 intervention and 251 control) patients were recruited and 2709 drugs were evaluated. About 26.5% of prescriptions were rated as potentially inappropriate and 21.5% were changed (9.1% discontinuation, 6.9% dose adjustment, 3.2% substitution and 2.2% new prescription). About 2.62 recommendations per patient were made and at least one recommendation was made for 95.6% of patients. The mean number of prescriptions per patient was significantly lower in the intervention group at 3- and 6-month follow-up. Discontinuations, dose adjustments and substitutions were significantly higher than in the control group at 3, 6 and 12 months. No differences were observed in the number of emergency visits, hospitalizations and deaths. Conclusion. The study intervention was safe, reduced potentially inappropriate medication, but did not reduce emergency visits and hospitalizations in polymedicated elderly people.

AB - Background. Polypharmacy is frequent in the elderly population and is associated with potentially drug inappropriateness and drug-related problems. Objectives. To assess the effectiveness and safety of a medication evaluation programme for community-dwelling polymedicated elderly people. Design. Randomized, open-label, multicentre, parallel-arm clinical trial with 1-year follow-up. Setting. Primary care centres. Participants. Polymedicated (≥8 drugs) elderly people (≥70 years). Study intervention. Pharmacist review of all medication according to the Good Palliative-Geriatric Practice algorithm and the Screening Tool of Older Person's Prescriptions-Screening Tool to Alert Doctors to the Right Treatment criteria and recommendations to the patient's physician. Control intervention. Routine clinical practice. Measurements. Recommendations and changes implemented, number of prescribed drugs, restarted drugs, primary care and emergency department consultations, hospitalizations and death. Results. About 503 (252 intervention and 251 control) patients were recruited and 2709 drugs were evaluated. About 26.5% of prescriptions were rated as potentially inappropriate and 21.5% were changed (9.1% discontinuation, 6.9% dose adjustment, 3.2% substitution and 2.2% new prescription). About 2.62 recommendations per patient were made and at least one recommendation was made for 95.6% of patients. The mean number of prescriptions per patient was significantly lower in the intervention group at 3- and 6-month follow-up. Discontinuations, dose adjustments and substitutions were significantly higher than in the control group at 3, 6 and 12 months. No differences were observed in the number of emergency visits, hospitalizations and deaths. Conclusion. The study intervention was safe, reduced potentially inappropriate medication, but did not reduce emergency visits and hospitalizations in polymedicated elderly people.

KW - Ageing

KW - Multidisciplinary care

KW - Pharmacology/drug reactions

KW - Primary care

KW - Public health

KW - Quality of care

UR - http://www.scopus.com/inward/record.url?scp=85014944234&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85014944234&partnerID=8YFLogxK

U2 - 10.1093/fampra/cmw073

DO - 10.1093/fampra/cmw073

M3 - Article

VL - 34

SP - 36

EP - 42

JO - Family Practice

JF - Family Practice

SN - 0263-2136

IS - 1

ER -