Polypharmacy and multimorbidity Signs and Symptoms Polypharmacy and multimorbidity
Conditions
Interventions
Practices will be recruited throughout Ireland, and will then be supported in recruiting eligible patients. Once all patients are recruited baseline data will be collected through medical record revie
Sponsors
The Health Research Board - Centre for Primary Care Research (Ireland)
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: Practice inclusion criteria: 1. Have 300 or more older patients (aged =65 years) on their patient panel (based on the need to identify at least 15 patients per practice who are receiving 15 or more medicines and allowing for refusals) 2. Use Socrates or Health One as a practice management system Patient inclusion crtieria: 1. Aged 65 years and over 2. Being prescribed at least 15 regular medications
Exclusion criteria
Exclusion criteria: Practice exclusion criteria: Involved in the development and piloting of the intervention or other concurrent medication quality related studies Patient exclusion criteria: 1. Significant mental or physical illness that would impair their ability to consent and take part in the study 2. Unable to attend the surgery for medication review (e.g. nursing home residents) 3. Those involved in another medication study
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| 1. Number of repeat medications are measured through medical record review at baseline and 6 months post-intervention 2. Proportion of patients with any potentially inappropriate prescription (PIP) (defined by explicit criteria, used for OPTI-SCRIPT which were based on more prevalent STOPP-START PIP indicators) are measured through medical record review at baseline and 6 months post-intervention | — |
Secondary
| Measure | Time frame |
|---|---|
| Current secondary outcome measures as of 17/07/2017: Measured through medical record review at baseline and 6 months post-intervention: 1. Reduction in proportion of patients with 15 or more medicines (100% at baseline) 2. Medication changes 2.1 Number of medications stopped 2.2 Numbers of medications started 2.3 Reduction in the number of PIP (per patient and absolute numbers in the intervention versus control 2.4 Proportion of patients with any reduction in PIP 3. Multimorbidity treatment burden questionnaire 4. Health related Quality of life (EQ5D) 5. Revised patient’s attitudes to deprescribing 6. Patient-reported adverse drug withdrawal events (defined as either recurrence of the condition for which the drug was prescribed or a physiologic reaction to drug withdrawal) 7. Health service utilisation (based on chart data and provided by practice admin staff) 7.1 Number of GP/nurse visits 7.2 Number of out of hours visits 7.3 Number of Accident & Emergency (A&E) visits 7.4 Number of hospital admissions 7.5 Number of in-patient days 7.6 Number of out-patient visits Previous secondary outcome measures: Measured through medical record review at baseline and 6 months post-intervention: 1. Reduction in proportion of patients with 15 or more medicines (100% at baseline) 2. Medication changes 2.1 Number of medications stopped 2.2 Numbers of medications started 2.3 Numbers of high risk medications 2.4 Adverse drug withdrawal events (Naranjo adverse drug reaction probability scale) 3. Treatment burden (Translated Treatment Burden Questionnaire) 4. Health related Quality of life (EQ5D) 5. Shared decision making (DCS) 6. Moriskey Medicacation Adherence Measure 7. Patients' attitudes towards deprescribing (PATD) 8. Health service utilisation (based on chart data and provided by practice admin staff) 8.1 Number of GP/nurse visits 8.2 Number of out of hours visits 8.3 Number of Accident & Emergency (A&E) visits 8.4 Number of hospital admissions 8.5 Number of in-patient days 8 | — |
Countries
Ireland
Outcome results
None listed