Team approach to polypharmacy evaluation and reduction: feasibility randomized trial of a structured clinical pathway to reduce polypharmacy

Pilot and Feasibility Studies

Research

Barbara Farrell¹  Larkin Lamarche²  Diana Sherifali²  James Gillett²  Kiska Colwill²  Jane Jurcic-Vrataric²  Julie Richardson²  Gina Agarwal²  Henry Siu²  Sayem Borhan²  Jeffery A. Templeton²  Abbas Ali²  Jenna Parascandalo²  Karla Freeman²  Kristina Frizzle²  Naomi Dore Brown²  Anne Holbrook²  Lehana Thabane²  Cathy Risdon²  Dee Mangin³  Lisa Dolovich⁴  Scott R. Garrison⁵  Johanna Trimble⁶  James McCormack⁶  Alan Cassels⁷ 

[1] Bruyère Research Institute, 43 Bruyère Street, Ottawa, ON, Canada;Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, L8P 1H6, Hamilton, ON, Canada;Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, L8P 1H6, Hamilton, ON, Canada;Dept. of General Practice, University of Otago, Christchurch, New Zealand;Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, L8P 1H6, Hamilton, ON, Canada;University of Toronto, 144 College Street, Toronto, ON, Canada;University of Alberta, 6-60 University Terrace, Edmonton, AB, Canada;University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, Canada;University of Victoria, 3800 Finnerty Rd, Victoria, BC, Canada;

关键词: Polypharmacy;    Deprescribing;    Multi-morbidity;    Patient safety;    Primary care;   

DOI  :  10.1186/s40814-023-01315-0

 received in 2021-11-22, accepted in 2023-05-02,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundPolypharmacy is associated with poorer health outcomes in older adults. Other than the associated multimorbidity, factors contributing to this association could include medication adverse effects and interactions, difficulties in managing complicated medication regimes, and reduced medication adherence. It is unknown how reversible these negative associations may be if polypharmacy is reduced. The purpose of this study was to determine the feasibility of implementing an operationalized clinical pathway aimed to reduce polypharmacy in primary care and to pilot measurement tools suitable for assessing change in health outcomes in a larger randomized controlled trial (RCT).MethodsWe randomized consenting patients ≥ 70 years old on ≥ 5 long-term medications into intervention or control groups. We collected baseline demographic information and research outcome measures at baseline and 6 months. We assessed four categories of feasibility outcomes: process, resource, management, and scientific. The intervention group received TAPER (team approach to polypharmacy evaluation and reduction), a clinical pathway for reducing polypharmacy using “pause and monitor” drug holiday approach. TAPER integrates patients’ goals, priorities, and preferences with an evidence-based “machine screen” to identify potentially problematic medications and support a tapering and monitoring process, all supported by a web-based system, TaperMD. Patients met with a clinical pharmacist and then with their family physician to finalize a plan for optimization of medications using TaperMD. The control group received usual care and were offered TAPER after follow-up at 6 months.ResultsAll 9 criteria for feasibility were met across the 4 feasibility outcome domains. Of 85 patients screened for eligibility, 39 eligible patients were recruited and randomized; two were excluded post hoc for not meeting the age requirement. Withdrawals (2) and losses to follow-up (3) were small and evenly distributed between arms. Areas for intervention and research process improvement were identified. In general, outcome measures performed well and appeared suitable for assessing change in a larger RCT.ConclusionsResults from this feasibility study indicate that TAPER as a clinical pathway is feasible to implement in a primary care team setting and in an RCT research framework. Outcome trends suggest effectiveness. A large-scale RCT will be conducted to investigate the effectiveness of TAPER on reducing polypharmacy and improving health outcomes.Trial registrationclinicaltrials.gov NCT02562352, Registered September 29, 2015.

【 授权许可】

CC BY   
© The Author(s) 2023

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