Effects of a comprehensive medication review intervention on health‐related quality of life and other clinical outcomes in geriatric outpatients with polypharmacy: A pragmatic randomized clinical trial

Abstract

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.

Medication changes implemented during medication reviews and factors related to overprescribing: post-hoc analyses of a randomized clinical trial in geriatric outpatients with polypharmacy

“…In this study, we deep-dived into the medicine changes that were implemented during the medication review intervention leading to improved HRQoL and reduced mortality. 3 The results in Table 1 show that even though there were three times the number of discontinuations (26% vs 8.7%) in the medication review group, the persistence of the discontinuations after 4 and 13 months were similar between groups (medication review: 91% at 4 months and 82% at 13 months; usual care: 83% at 4 months and 86% at 13 months). The high persistence in the medication review group despite the larger number of changes could be due to improved cross-sectoral communication as the patient's general practitioner (GP) was involved before implementation of the changes and notified of the changes after implementation.…”

“…Detailed patient characteristics and patient flowchart have previously been reported. 3 Medicines prescribed at baseline are listed in Supporting Information Table S1.…”

“…2 We have previously reported on the clinical effects of medication reviews as a supplement to usual care in a geriatric outpatient clinic. 3 In a randomized clinical trial, medication reviews reduced the number of medicines after 4 months and led to relative increases in the patient's health-related quality of life (HRQoL) and reduced mortality.…”

Medication changes implemented during medication reviews and factors related to overprescribing: post-hoc analyses of a randomized clinical trial in geriatric outpatients with polypharmacy

“…For a detailed description of the trial see the primary publication. 3 Briefly, participants taking 9 or more different medicines were recruited from the geriatric outpatient clinic at Copenhagen University Hospital, Bispebjerg and Frederiksberg from June 2017 to December 2019. Participants were randomized to usual care or usual care plus a medication consultation including a medication review and increased cross-sectoral communication (termed the medication review group).…”

Physician‐led medication reviews in polypharmacy patients treated with at least 12 medications in a type 2 diabetes outpatient clinic: A randomised trial

“…12 Our research group has previously shown that medication reviews in a geriatric outpatient setting can reduce polypharmacy, decrease mortality and increase health-related quality of life (HRQoL). 13 In Denmark, patients with chronic diseases such as type 2 diabetes often have recurring outpatient visits, creating unexploited opportunities for medication reviews. 14 We set out to evaluate the effect of physician-led medication reviews and increased cross-sectoral communication as a supplement to standard care in a type 2 diabetes outpatient clinic.…”