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.

Keywords: geriatrics; health-related quality of life; medication reviews; polypharmacy.

FIGURE 1

Patient flow through the study. Only data collection of the primary outcome measure (EQ‐5D‐5L index value) is depicted

FIGURE 2

(A) Results from the analysis of the primary outcome measure showing the difference in change from baseline in health‐related quality of life between groups from baseline to follow‐up after 4 months, including subjects who died during follow‐up. The error bars are 95% confidence intervals for the estimated marginal means. The secondary outcome (change from baseline to follow‐up after 13 months) is also depicted since both outcomes were analysed in the same constrained linear mixed model adjusted for the stratification variables: number of medicines at baseline (three levels), age at baseline (three levels) and sex (two levels). CI, confidence interval; EQ‐5D‐5L, EuroQoL 5‐dimension 5‐level. (B) Cumulative incidence curves showing the incidence of death in the control and intervention groups. Hazard ratios were calculated using an adjusted Cox proportional hazards model. CI, confidence interval; HR, hazard ratio. (C) Numbers at risk of dying during the study. Only four patients withdrew consent and were censored prior to the end of the study