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 ToniCasas 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, Palacio Ana, 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

20 Scopus citations

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 - Jan 1 2017

Keywords

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

ASJC Scopus subject areas

  • Family Practice

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    Campins, L., Serra-Prat, M., Gózalo, I., López, D., Palomera, E., Agustí, C., Cabré, M., Maite, A. M., Maria, A., Antònia, A., Sánchez, A., Mireia, B., Eugènia, B., Maria, B., Montserrat, B., Isaac, B., Marta, C., Marcella, C., Dolors, 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