Polypharmacy Other
Conditions
Interventions
Details of the randomisation process
Randomisation will be generated using a computer algorithm. Practices will not be informed of whether or not they will be intervention practices before agreeing to
Sponsors
University of Bristol
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: Persons experiencing potentially problematic polypharmacy in primary care and community settings. This will specifically include “hard to reach” groups, including nursing home residents, housebound individuals, and those who lack capacity to consent (e.g. dementia). The exact patient population will be defined as part of the case finding approach to be determined by the development phase (Phase 1) of the project. It is anticipated the case finding tool will identify older people (=60 years) who are receiving 10 or more medications regularly on prescription. This is because people in this group are more likely than younger people on fewer medications to trigger at least one of the prescribing quality indicators (being defined within Phase 1) which will underpin the case finding approach.
Exclusion criteria
Exclusion criteria: 1. Individuals receiving end-of-life care 2. Patients judged by their GP to have chaotic medication use (e.g. history of drug or alcohol misuse) 3. The GP deems contact to be inappropriate; for example, due to severe mental health problems, terminal illness, recent bereavement 4. Participant is unable to complete the study questionnaires or medication review appointment (either themselves or with the help of carers) 5. Individuals planning to move GP practice within the 6-month follow-up period
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Potentially inappropriate prescribing captured via patient notes pre-randomisation (T1), immediately pre-intervention delivery (T2), immediately post-intervention delivery (T3) and follow-up at 6 months (T4) | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Patient experience: 1.1. Quality of life (EQ-5D, SF-12), medication adherence (patient-reported), burden of treatment (MTBQ) and medication literacy captured via questionnaire pre-randomisation (T1), immediately pre-intervention delivery (T2) and follow-up at 6 months (T4) 1.2. Medication adherence (prescription refills) captured via patient notes pre-randomisation (T1), immediately pre-intervention delivery (T2) and follow-up at 6 months (T4) 2. Health service utilisation: unplanned hospital admissions, primary care consultation rate, other hospital utilisation data (A&E) other service use (social care, private, etc) captured via patient notes and questionnaire pre-randomisation(T1), immediately pre-intervention delivery (T2) and follow-up at 6 months (T4) 3. Patient/medication safety: medication-related admissions, inappropriate polypharmacy score, all-cause mortality captured via patient notes pre-randomisation(T1), immediately pre-intervention delivery(T2) and follow-up at 6 months (T4) 4. Experience of medication review captured via questionnaire pre-randomisation(T1) and immediately post-intervention delivery (T3) | — |
Countries
England, United Kingdom
Contacts
Public ContactDeborah McCahon
Outcome results
None listed