Effect of a patient-centred deprescribing procedure in older multimorbid patients in Swiss primary care - A cluster-randomised clinical trial.
Deprescribing
Effectiveness
Older patient
Polypharmacy
Primary care
Public health
Randomised controlled trial
Journal
BMC geriatrics
ISSN: 1471-2318
Titre abrégé: BMC Geriatr
Pays: England
ID NLM: 100968548
Informations de publication
Date de publication:
16 11 2020
16 11 2020
Historique:
received:
07
02
2020
accepted:
03
11
2020
entrez:
17
11
2020
pubmed:
18
11
2020
medline:
14
1
2021
Statut:
epublish
Résumé
Management of patients with polypharmacy is challenging, and evidence for beneficial effects of deprescribing interventions is mixed. This study aimed to investigate whether a patient-centred deprescribing intervention of PCPs results in a reduction of polypharmacy, without increasing the number of adverse disease events and reducing the quality of life, among their older multimorbid patients. This is a cluster-randomised clinical study among 46 primary care physicians (PCPs) with a 12 months follow-up. We randomised PCPs into an intervention and a control group. They recruited 128 and 206 patients if ≥60 years and taking ≥five drugs for ≥6 months. The intervention consisted of a 2-h training of PCPs, encouraging the use of a validated deprescribing-algorithm including shared-decision-making, in comparison to usual care. The primary outcome was the mean difference in the number of drugs per patient (dpp) between baseline and after 12 months. Additional outcomes focused on patient safety and quality of life (QoL) measures. Three hundred thirty-four patients, mean [SD] age of 76.2 [8.5] years participated. The mean difference in the number of dpp between baseline and after 12 months was 0.379 in the intervention group (8.02 and 7.64; p = 0.059) and 0.374 in the control group (8.05 and 7.68; p = 0.065). The between-group comparison showed no significant difference at all time points, except for immediately after the intervention (p = 0.002). There were no significant differences concerning patient safety nor QoL measures. Our straight-forward and patient-centred deprescribing procedure is effective immediately after the intervention, but not after 6 and 12 months. Further research needs to determine the optimal interval of repeated deprescribing interventions for a sustainable effect on polypharmacy at mid- and long-term. Integrating SDM in the deprescribing process is a key factor for success. Current Controlled Trials, prospectively registered ISRCTN16560559 Date assigned 31/10/2014. The Prevention of Polypharmacy in Primary Care Patients Trial (4P-RCT).
Sections du résumé
BACKGROUND
Management of patients with polypharmacy is challenging, and evidence for beneficial effects of deprescribing interventions is mixed. This study aimed to investigate whether a patient-centred deprescribing intervention of PCPs results in a reduction of polypharmacy, without increasing the number of adverse disease events and reducing the quality of life, among their older multimorbid patients.
METHODS
This is a cluster-randomised clinical study among 46 primary care physicians (PCPs) with a 12 months follow-up. We randomised PCPs into an intervention and a control group. They recruited 128 and 206 patients if ≥60 years and taking ≥five drugs for ≥6 months. The intervention consisted of a 2-h training of PCPs, encouraging the use of a validated deprescribing-algorithm including shared-decision-making, in comparison to usual care. The primary outcome was the mean difference in the number of drugs per patient (dpp) between baseline and after 12 months. Additional outcomes focused on patient safety and quality of life (QoL) measures.
RESULTS
Three hundred thirty-four patients, mean [SD] age of 76.2 [8.5] years participated. The mean difference in the number of dpp between baseline and after 12 months was 0.379 in the intervention group (8.02 and 7.64; p = 0.059) and 0.374 in the control group (8.05 and 7.68; p = 0.065). The between-group comparison showed no significant difference at all time points, except for immediately after the intervention (p = 0.002). There were no significant differences concerning patient safety nor QoL measures.
CONCLUSION
Our straight-forward and patient-centred deprescribing procedure is effective immediately after the intervention, but not after 6 and 12 months. Further research needs to determine the optimal interval of repeated deprescribing interventions for a sustainable effect on polypharmacy at mid- and long-term. Integrating SDM in the deprescribing process is a key factor for success.
TRIAL REGISTRATION
Current Controlled Trials, prospectively registered ISRCTN16560559 Date assigned 31/10/2014. The Prevention of Polypharmacy in Primary Care Patients Trial (4P-RCT).
Identifiants
pubmed: 33198634
doi: 10.1186/s12877-020-01870-8
pii: 10.1186/s12877-020-01870-8
pmc: PMC7670707
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
471Subventions
Organisme : Gottfried und Julia Bangerter-Rhyner-Stiftung
ID : 8472
Pays : International
Références
PLoS One. 2014 Aug 19;9(8):e105425
pubmed: 25136981
BMJ. 2020 Jun 18;369:m1822
pubmed: 32554566
Age Ageing. 2017 Mar 1;46(2):291-299
pubmed: 27836856
PLoS One. 2016 Mar 04;11(3):e0149984
pubmed: 26942907
Trials. 2016 Jan 29;17:57
pubmed: 26822311
Age Ageing. 2017 Jul 1;46(4):600-607
pubmed: 28119312
Br J Clin Pharmacol. 2014 Dec;78(6):1201-16
pubmed: 24698145
Health Policy. 1990 Dec;16(3):199-208
pubmed: 10109801
Drugs Aging. 2013 Oct;30(10):793-807
pubmed: 23912674
Trials. 2013 Dec 05;14:420
pubmed: 24308282
BMC Geriatr. 2014 Nov 18;14:116
pubmed: 25407349
Br J Gen Pract. 2009 Jan;59(558):29-36
pubmed: 19105913
PLoS One. 2017 Dec 19;12(12):e0188499
pubmed: 29261695
Br J Clin Pharmacol. 2020 Oct;86(10):1958-1968
pubmed: 30937937
BMJ. 2015 Jan 20;350:h176
pubmed: 25646760
Stud Health Technol Inform. 2006;124:809-14
pubmed: 17108613
J Am Med Inform Assoc. 2010 Jan-Feb;17(1):25-33
pubmed: 20064798
Qual Life Res. 2014 Mar;23(2):443-7
pubmed: 23921597
Am J Med. 1996 Apr;100(4):428-37
pubmed: 8610730
Br J Clin Pharmacol. 2006 Feb;61(2):218-23
pubmed: 16433876
Br J Clin Pharmacol. 2016 Aug;82(2):532-48
pubmed: 27059768
BMC Geriatr. 2017 Oct 16;17(Suppl 1):231
pubmed: 29047332
BMC Fam Pract. 2012 Nov 24;13:113
pubmed: 23181753
Maturitas. 2017 Mar;97:66-68
pubmed: 28081964
BMC Fam Pract. 2018 Jul 9;19(1):110
pubmed: 29986668
JAMA Intern Med. 2013 Sep 9;173(16):1546-7
pubmed: 23752793
Br J Clin Pharmacol. 2016 Nov;82(5):1382-1392
pubmed: 27426227
Drugs Aging. 2014 Apr;31(4):291-8
pubmed: 24566877
Health Qual Life Outcomes. 2016 Sep 20;14(1):133
pubmed: 27644755
Isr Med Assoc J. 2007 Jun;9(6):430-4
pubmed: 17642388
J Am Med Dir Assoc. 2018 Nov;19(11):923-935.e2
pubmed: 30108032
BMC Geriatr. 2016 Jan 15;16:15
pubmed: 26767619
Age Ageing. 2007 Nov;36(6):632-8
pubmed: 17881418
BMJ Open. 2013 Sep 13;3(9):e003610
pubmed: 24038011
BMC Fam Pract. 2019 May 14;20(1):64
pubmed: 31088397
Drug Saf. 2012 Feb 1;35(2):105-26
pubmed: 22201475
BMC Public Health. 2011 Feb 14;11:101
pubmed: 21320345
BMJ. 2012 Sep 04;345:e5661
pubmed: 22951546
Age Ageing. 2018 Mar 01;47(2):261-268
pubmed: 29281041
Health Syst Transit. 2015;17(4):1-288, xix
pubmed: 26766626
Swiss Med Wkly. 2014 Dec 23;144:w14073
pubmed: 25668157
Br J Clin Pharmacol. 2014 Jun;77(6):1073-82
pubmed: 24428591
Br J Clin Pharmacol. 2014 Oct;78(4):738-47
pubmed: 24661192
Drugs Aging. 2018 Jul;35(7):575-587
pubmed: 30006810
BMC Complement Altern Med. 2010 Jan 25;10:3
pubmed: 20100343
Praxis (Bern 1994). 2011 Sep 7;100(18):1085-95
pubmed: 21932197
BMC Geriatr. 2009 Jan 28;9:5
pubmed: 19175914
Praxis (Bern 1994). 2014 Mar 12;103(6):317-22
pubmed: 24618310
BMJ. 2012 Sep 03;345:e5205
pubmed: 22945950
Age Ageing. 2007 May;36(3):292-7
pubmed: 17387123
BMJ. 2013 Nov 28;347:f7033
pubmed: 24286985
Arch Intern Med. 2010 Oct 11;170(18):1648-54
pubmed: 20937924
Int J Med Inform. 2015 Nov;84(11):920-32
pubmed: 26296433
N Engl J Med. 2011 Nov 24;365(21):2002-12
pubmed: 22111719
Eur J Clin Pharmacol. 2012 Sep;68(9):1309-19
pubmed: 22392557
Br J Clin Pharmacol. 2016 Sep;82(3):583-623
pubmed: 27077231
JAMA. 1998 Apr 15;279(15):1200-5
pubmed: 9555760
BMC Fam Pract. 2015 Feb 07;16:16
pubmed: 25881287
Br J Clin Pharmacol. 2017 May;83(5):942-952
pubmed: 27891666
BMC Fam Pract. 2018 Jul 28;19(1):131
pubmed: 30055583
BMC Med Inform Decis Mak. 2015 Oct 12;15:82
pubmed: 26459233
Drugs Aging. 2012 Nov;29(11):925-6; author reply 927-8
pubmed: 23138832
Eur J Clin Pharmacol. 2011 Nov;67(11):1175-88
pubmed: 21584788
Trials. 2015 Aug 26;16:380
pubmed: 26306691
BMJ Open. 2015 Dec 09;5(12):e009235
pubmed: 26656020
Br J Gen Pract. 2002 Dec;52(485):1012-20
pubmed: 12528590
Patient Prefer Adherence. 2017 Aug 22;11:1451-1458
pubmed: 28860728