Aim To investigate the effects of a comprehensive medication review intervention on health‐related quality of life (HRQoL) and clinical outcomes in geriatric outpatients exposed to polypharmacy. Methods Pragmatic, nonblinded, randomized clinical trial with follow‐up after 4 and 13 months. Participants were geriatric outpatients taking ≥9 medicines. The intervention was an additional consultation with a physician focusing on reviewing medication, informing patients about their medicines and increasing cross‐sectoral communication as supplement to and compared with usual care. The primary outcome was change in HRQoL after 4 months measured with the EuroQoL 5‐dimension 5‐level (EQ‐5D‐5L) questionnaire. Secondary outcomes were HRQoL after 13 months, mortality, admissions, falls and number of medicines after 4 and 13 months. Results Of 785 eligible patients, 408 were included (age: mean 80.6 [standard deviation 7.22] years; number of medicines: median 12 [interquartile range 10–14]; females 71%). After 4 months, the adjusted between‐group difference in EQ‐5D‐5L index score was 0.066 in favour of the medication consultation (95% confidence interval 0.01 to 0.12, P = .02). After 4 months, two (1%) participants had died in the medication‐consultation group and nine (4%) in the usual‐care group (log‐rank test, P = .045). The medication consultation reduced the number of medicines by 2.0 (15.8%) after 4 months and 1.3 (10.7%) after 13 months. There were no statistically significant differences in mortality or HRQoL after 13 months, and no differences in falls or admissions. Conclusions An additional consultation with medication review and increased communication as supplement to usual geriatric outpatient care improved HRQoL and reduced mortality after 4 months.
AimsTo provide posthoc analyses of a clinical trial that reported beneficial effects of medication reviews on health‐related quality of life. Specifically, to describe the medication changes with a focus on deprescribing and to explore patient‐ and medication‐related factors that may identify patients most likely to benefit from medication reviews.MethodsPosthoc analyses of data from a pragmatic, nonblinded, randomized clinical trial investigating a medication review intervention (NCT03911934) in 408 geriatric outpatients treated with ≥9 medicines.ResultsIn the medication review group (n = 196), 26% of the medicines prescribed at baseline were discontinued with 82% still being discontinued after 13 months. The most common reason for discontinuation was lack of indication (72% of discontinuations). The medicines most often discontinued in the medication review group compared with usual care included: metoclopramide (11/15 = 73% discontinued vs. 1/12 = 8% in usual care), acetylsalicylic acid (20/48 = 42% vs. 2/47 = 4%), simvastatin (18/48 = 38% vs. 2/58 = 3%), zopiclone (23/59 = 39% vs. 4/54 = 7%), quinine (9/14 = 64% vs. 6/16 = 38%), citalopram (4/18 = 22% vs. 0/20 = 0%) and tramadol (18/37 = 49% vs. 8/30 = 27%). Factors associated with number of deprescribed medicines included: number of prescribed medicines, Drug Burden Index, patient motivation for medicine changes, and prescriptions of metoclopramide, iron preparations, antidepressants other than selective serotonin reuptake inhibitors, nonsteroidal anti‐inflammatory drugs, or drugs for urinary incontinence.ConclusionPhysician‐led medication reviews resulted in persistent deprescribing of medicines in older polypharmacy patients treated with ≥9 medicines. Motivation for having their medicine changed, treatment with more medicines, and a higher burden of sedative and anticholinergic medicines characterized the patients most likely to benefit from physician‐led medication reviews.
Aims: To describe the medication changes implemented during physician-led medication reviews that resulted in improved health-related quality of life; and to explore factors that could identify patients with overprescription. Methods: Post-hoc analyses of data from a pragmatic, non-blinded, randomized clinical trial investigating a medication review intervention (NCT03911934) in 408 geriatric outpatients taking ≥9 medicines. Results: The most frequent medicine change in the medication review group (n=196) was discontinuation (26% of the medicines) due to lack of indication (72% of the discontinuations). After 13 months, 82% of the discontinued medicines were persistently discontinued. The medicines most often discontinued in the medication review group compared with usual care included: metoclopramide (11/5=73% discontinued vs 1/12=8% in usual care), acetylsalicylic acid (20/48=42% vs 2/47=4%), simvastatin (18/48=38% vs 2/58=3%), zopiclone (23/59=39% vs 4/54=7%), quinine (9/14=64% vs 6/16=38%), citalopram (4/18=22% vs 0/20=0%), and tramadol (18/37=49% vs 8/30=27%). Factors associated with the number of overprescribed medicines included: number of prescribed medicines (8% increase per medicine), Drug Burden Index (15% increase per 1 increase), and patient motivation for medicine changes (26% less if not motivated). Prescriptions of metoclopramide, iron preparations, antidepressants other than SSRIs, NSAIDs, or drugs for urinary incontinence were associated with a higher number of overprescribed medicines. Conclusion: Medication reviews can be used to persistently discontinue overprescribed medicines in older polypharmacy patients. Motivation for having their medicine changed, treatment with a higher number of medicines, and a higher burden of sedative and anticholinergic drugs characterized patients most likely to benefit from physician-led medication reviews.
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