Effectiveness of a complex intervention on Prioritising Multimedication in Multimorbidity (PRIMUM) in primary care : results of a pragmatic cluster randomised controlled trial

  • Objectives: Investigate the effectiveness of a complex intervention aimed at improving the appropriateness of medication in older patients with multimorbidity in general practice. Design: Pragmatic, cluster randomised controlled trial with general practice as unit of randomisation. Setting: 72 general practices in Hesse, Germany. Participants: 505 randomly sampled, cognitively intact patients (≥60 years, ≥3 chronic conditions under pharmacological treatment, ≥5 long-term drug prescriptions with systemic effects); 465 patients and 71 practices completed the study. Interventions: Intervention group (IG): The healthcare assistant conducted a checklist-based interview with patients on medication-related problems and reconciled their medications. Assisted by a computerised decision support system, the general practitioner optimised medication, discussed it with patients and adjusted it accordingly. The control group (CG) continued with usual care. Outcome measures: The primary outcome was a modified Medication Appropriateness Index (MAI, excluding item 10 on cost-effectiveness), assessed in blinded medication reviews and calculated as the difference between baseline and after 6 months; secondary outcomes after 6 and 9 months’ follow-up: quality of life, functioning, medication adherence, and so on. Results: At baseline, a high proportion of patients had appropriate to mildly inappropriate prescriptions (MAI 0–5 points: n=350 patients). Randomisation revealed balanced groups (IG: 36 practices/252 patients; CG: 36/253). Intervention had no significant effect on primary outcome: mean MAI sum scores decreased by 0.3 points in IG and 0.8 points in CG, resulting in a non-significant adjusted mean difference of 0.7 (95% CI −0.2 to 1.6) points in favour of CG. Secondary outcomes showed non-significant changes (quality of life slightly improved in IG but continued to decline in CG) or remained stable (functioning, medication adherence). Conclusions: The intervention had no significant effects. Many patients already received appropriate prescriptions and enjoyed good quality of life and functional status. We can therefore conclude that in our study, there was not enough scope for improvement. Trial registration number: ISRCTN99526053. NCT01171339; Results.
Author:Christiane Muth, Lorenz Uhlmann, Walter E. Haefeli, Justine Rochon, J. M. van den Akker, Rafael Perera, Corina GüthlinGND, Martin Beyer, Frank Oswald, José María Valderas-Martínez, André J. Knottnerus, Ferdinand M. GerlachORCiDGND, Sebastian Harder
Pubmed Id:https://pubmed.ncbi.nlm.nih.gov/29478012
Parent Title (English):BMJ open
Publisher:BMJ Publishing Group
Place of publication:London
Document Type:Article
Year of Completion:2018
Date of first Publication:2018/02/24
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2018/03/08
Tag:Medication Appropriateness Index; computer-assisted drug therapy; medication reconciliation; multimorbidity; multiple chronic conditions; polypharmacy
Issue:2, e017740
Page Number:17
First Page:1
Last Page:16
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Institutes:Erziehungswissenschaften / Erziehungswissenschaften
Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (English):License LogoCreative Commons - Namensnennung-Nicht kommerziell 4.0