Donna Bosch-Lenders1, Jesse Jansen1, Henri E J H Jelle Stoffers1, Bjorn Winkens2, Karin Aretz3, Mascha Twellaar1, Jos M G A Schols4, Paul-Hugo M van der Kuy5, J André Knottnerus1, Marjan van den Akker1,6,7. 1. Department of Family Medicine, Care and Public Health Research Institute (CAHPRI), Maastricht University, 6200 MD Maastricht, The Netherlands. 2. Department of Methodology and Statistics, Care and Public Health Research Institute (CAHPRI), Maastricht University, 6200 MD Maastricht, The Netherlands. 3. MEMIC, Center for Data and Information Management, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands. 4. Department of Health Services Research, Care and Public Health Research Institute (CAHPRI), Maastricht University, 6200 MD Maastricht, The Netherlands. 5. Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands. 6. Institute of General Practice, Goethe University, 60590 Frankfurt am Main, Germany. 7. Academic Centre of General Practice, Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium.
Abstract
Background: We conducted a comprehensive medication review at the patients' home, using data from electronic patient records, and with input from relevant specialists, general practitioners and pharmacists formulated and implemented recommendations to optimize medication use in patients aged 60+ years with polypharmacy. We evaluated the effect of this medication review on quality of life (QoL) and medication use. Methods: Cluster randomized controlled trial (stepped wedge), randomly assigning general practices to one of three consecutive steps. Patients received usual care until the intervention was implemented. Primary outcome was QoL (SF-36 and EQ-5D); secondary outcomes were medication changes, medication adherence and (instrumental) activities of daily living (ADL, iADL) which were measured at baseline, and around 6- and 12-months post intervention. Results:Twenty-four general practices included 360 women and 410 men with an average age of 75 years (SD 7.5). A positive effect on SF-36 mental health (estimated mean was stable in the intervention, but decreased in the control condition with -6.1, p = 0.009,) was found with a reduced number of medications at follow-up compared to the control condition. No significant effects were found on other QoL subscales, ADL, iADL or medication adherence. Conclusion: The medication review prevented decrease of mental health (SF36), with no significant effects on other outcome measures, apart from a reduction in the number of prescribed medications.
RCT Entities:
Background: We conducted a comprehensive medication review at the patients' home, using data from electronic patient records, and with input from relevant specialists, general practitioners and pharmacists formulated and implemented recommendations to optimize medication use in patients aged 60+ years with polypharmacy. We evaluated the effect of this medication review on quality of life (QoL) and medication use. Methods: Cluster randomized controlled trial (stepped wedge), randomly assigning general practices to one of three consecutive steps. Patients received usual care until the intervention was implemented. Primary outcome was QoL (SF-36 and EQ-5D); secondary outcomes were medication changes, medication adherence and (instrumental) activities of daily living (ADL, iADL) which were measured at baseline, and around 6- and 12-months post intervention. Results: Twenty-four general practices included 360 women and 410 men with an average age of 75 years (SD 7.5). A positive effect on SF-36 mental health (estimated mean was stable in the intervention, but decreased in the control condition with -6.1, p = 0.009,) was found with a reduced number of medications at follow-up compared to the control condition. No significant effects were found on other QoL subscales, ADL, iADL or medication adherence. Conclusion: The medication review prevented decrease of mental health (SF36), with no significant effects on other outcome measures, apart from a reduction in the number of prescribed medications.
Entities:
Keywords:
cluster-randomized controlled trial; general practitioner; home visit; medication review; patient; pharmacist; polypharmacy; primary care
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