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

BMJ Open
Christiane MuthSebastian Harder

Abstract

Investigate the effectiveness of a complex intervention aimed at improving the appropriateness of medication in older patients with multimorbidity in general practice. Pragmatic, cluster randomised controlled trial with general practice as unit of randomisation. 72 general practices in Hesse, Germany. 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. 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. 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. At basel...Continue Reading

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Citations

May 10, 2020·The Cochrane Database of Systematic Reviews·Amanda J CrossJohnson George
Aug 26, 2020·British Journal of Clinical Pharmacology·Joanne Reeve
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Aug 24, 2021·Journal of Comorbidity·Francisca Leiva-FernándezUNKNOWN MULTIPAP Group

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Software Mentioned

EXCEL
PaT Plot
NCSS
nlme
PRIMUM
PASS
xtable
R
lme4

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