Randomized controlled trial of an intervention to improve drug appropriateness in community-dwelling polymedicated elderly people

Abstract

Background: Polypharmacy is frequent in the elderly population and is associated with potentially drug inappropriateness and drug-related problems.

Objectives: To assess the effectiveness and safety of a medication evaluation programme for community-dwelling polymedicated elderly people.

Design: Randomized, open-label, multicentre, parallel-arm clinical trial with 1-year follow-up.

Setting: Primary care centres.

Participants: Polymedicated (≥8 drugs) elderly people (≥70 years).

Study intervention: Pharmacist review of all medication according to the Good Palliative-Geriatric Practice algorithm and the Screening Tool of Older Person's Prescriptions-Screening Tool to Alert Doctors to the Right Treatment criteria and recommendations to the patient's physician.

Control intervention: Routine clinical practice.

Measurements: Recommendations and changes implemented, number of prescribed drugs, restarted drugs, primary care and emergency department consultations, hospitalizations and death.

Results: About 503 (252 intervention and 251 control) patients were recruited and 2709 drugs were evaluated. About 26.5% of prescriptions were rated as potentially inappropriate and 21.5% were changed (9.1% discontinuation, 6.9% dose adjustment, 3.2% substitution and 2.2% new prescription). About 2.62 recommendations per patient were made and at least one recommendation was made for 95.6% of patients. The mean number of prescriptions per patient was significantly lower in the intervention group at 3- and 6-month follow-up. Discontinuations, dose adjustments and substitutions were significantly higher than in the control group at 3, 6 and 12 months. No differences were observed in the number of emergency visits, hospitalizations and deaths.

Conclusion: The study intervention was safe, reduced potentially inappropriate medication, but did not reduce emergency visits and hospitalizations in polymedicated elderly people.

Trial registration: ClinicalTrials.gov NCT02275572.

Keywords: Ageing; multidisciplinary care; pharmacology/drug reactions; primary care; public health; quality of care..