Optimising prescribing in older adults with multimorbidity and polypharmacy in primary care (OPTICA): cluster randomised clinical trial

BMJ, Journal Year: 2023, Volume and Issue: unknown, P. e074054 - e074054

Published: May 24, 2023

To study the effects of a primary care medication review intervention centred around an electronic clinical decision support system (eCDSS) on appropriateness and number prescribing omissions in older adults with multimorbidity polypharmacy compared discussion about line usual care.Cluster randomised trial.Swiss care, between December 2018 February 2021.Eligible patients were ≥65 years age three or more chronic conditions five long term medications.The to optimise pharmacotherapy eCDSS was conducted by general practitioners, followed shared making practitioners patients, practitioners.Primary outcomes improvement Medication Appropriateness Index (MAI) Assessment Underutilisation (AOU) at 12 months. Secondary included medications, falls, fractures, quality life.In 43 practitioner clusters, 323 recruited (median 77 (interquartile range 73-83) years; 45% (n=146) women). Twenty one 160 assigned group 22 163 control group. On average, recommendation stop start reported be implemented per patient. At months, results intention-to-treat analysis (odds ratio 1.05, 95% confidence interval 0.59 1.87) (0.90, 0.41 1.96) inconclusive. The same case for protocol analysis. No clear evidence found difference safety month follow-up, but fewer events than six months.In this trial adults, inconclusive as whether use led reduction months care. Nevertheless, could safely delivered without causing any harm patients.NCT03724539Clinicaltrials.gov NCT03724539.

Language: Английский

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Older adults’ attitudes towards deprescribing and medication changes: a longitudinal sub-study of a cluster randomised controlled trial

BMJ Open, Journal Year: 2024, Volume and Issue: 14(1), P. e075325 - e075325

Published: Jan. 1, 2024

Objective To investigate the association between older patients’ willingness to have one or more medications deprescribed and: (1) change in medications, (2) appropriateness of and (3) implementation prescribing recommendations generated by electronic decision support system tested ‘Optimising PharmacoTherapy In Multimorbid Elderly Primary CAre’ (OPTICA) trial. Design A longitudinal sub-study OPTICA trial, a cluster randomised controlled Setting Swiss primary care settings. Participants were aged ≥65 years, with ≥3 chronic conditions ≥5 regular recruited from 43 general practitioner (GP) practices. Exposures Patients’ was assessed using three questions ‘revised Patient Attitudes Towards Deprescribing’ (rPATD) questionnaire its concerns about stopping score. Measures/analyses Medication-related outcomes collected at 1 year follow-up. Aim outcome: number long-term baseline 12 month 2 medication (Medication Appropriateness Index). 3 binary variable on whether any recommendation during review implemented. We used multilevel linear regression analyses (aim aim 2) logistic 3). Models adjusted for sociodemographic variables clustering effect GP level. Results 298 patients completed rPATD, 45% women 78 years median age. statistically significant found score over time (per 1-unit increase average use 0.65 higher; 95% CI: 0.08 1.22). Other than that we did not find evidence associations agreement deprescribing medication-related outcomes. Conclusions an most measures patient year. Trial registration NCT03724539 .

Language: Английский

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Postprandial Plasma Glucose Measured from Blood Taken between 4 and 7.9 h Is Positively Associated with Mortality from Hypertension and Cardiovascular Disease

Journal of Cardiovascular Development and Disease, Journal Year: 2024, Volume and Issue: 11(2), P. 53 - 53

Published: Feb. 4, 2024

It is unknown whether postprandial plasma glucose measured from blood taken between 4 and 7.9 h (PPG4–7.9h) associated with mortality hypertension, diabetes, or cardiovascular disease (CVD). This study aimed to investigate these associations in 4896 US adults who attended the third National Health Nutrition Examination Survey. Cox proportional hazards models were used estimate hazard ratios (HRs) 95% confidence intervals (CIs) of PPG4–7.9h for mortality. cohort was followed up 106,300 person-years (mean follow-up, 21.7 years). A 1-natural-log-unit increase a higher risk hypertension (HR, 3.50; CI, 2.34–5.24), diabetes 11.7; 6.85–20.0), CVD 2.76; 2.08–3.68) after adjustment all tested confounders except hemoglobin A1c (HbA1c). After further HbA1c, remained positively both 2.15; 1.13–4.08) 1.62; 1.05–2.51), but no longer Subgroup analyses showed that similar results obtained sub-cohort participants without prior diagnosis myocardial infarction stroke. In conclusion, predicts CVD, independent HbA1c.

Language: Английский

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The impact of the COVID-19 pandemic on the continuity of care for at-risk patients in Swiss primary care settings: A mixed-methods study

Social Science & Medicine, Journal Year: 2022, Volume and Issue: 298, P. 114858 - 114858

Published: Feb. 24, 2022

Continuity of care is important for the health aging individuals with comorbidities. When initial coronavirus mitigation campaigns involved messaging such as "Stay at home-stay safe," and banned provision non-urgent care, at-risk patients depending upon regular consultations general practitioners (GPs) faced confusion about possibility seeking non-COVID-19 related healthcare. We employed a sequential explanatory mixed-methods design, consisting quantitative component followed by qualitative component, to understand patients' services use during COVID-19 pandemic in Switzerland. Quantitatively, we used electronic medical records data from 272 GPs 266,796 patients. Based on pre-pandemic data, predicted weekly consultation counts well measurement (blood pressure, glycated hemoglobin, low-density lipoprotein cholesterol) per 100 that would be expected 2020 absence compared those actual observed values. Qualitatively, conducted 23 semi-structured interviews 24 (∼45 min) 37 (∼35 min). Quantitative results demonstrate significant decrease first shutdown period, quickly returning normal moving within values rest 2020. Qualitative contextualize these findings describing constantly implementing material, administrative, communication changes. reported gaps authorities noted lack clear guidelines delineating how define "at-risk patients" what cases were "urgent" treat shutdowns. Patient show patient-level factors, fear contracting coronavirus, perceptions overburdened, sense solidarity, influenced decisions consult less beginning pandemic. Findings periods provide valuable lessons future preparedness, particularly need contingency plans overall healthcare system instead focusing only infectious agent itself.

Language: Английский

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Postprandial Plasma Glucose Measured from Blood Taken between 4 and 7.9 H Is Positively Associated with Mortality from Hypertension and Cardiovascular Disease

Published: Jan. 9, 2024

It is unknown whether postprandial plasma glucose measured from blood taken between 4 and 7.9 h (PPG4-7.9h) associated with mortality hypertension, diabetes, or cardiovascular disease (CVD). This study aimed to investigate these associations in 4,896 US adults who attended the third National Health Nutrition Examination Survey. Cox proportional hazards models were used estimate hazard ratios (HRs) 95% confidence intervals (CIs) of PPG4-7.9h for mortality. cohort was followed up 106,300 person-years (mean follow-up, 21.7 years). A 1-natural-log-unit increase a higher risk hypertension (HR, 3.50; CI, 2.34-5.24), diabetes 11.7; 6.85-20.0), CVD 2.76; 2.08-3.68) after adjustment all tested confounders except hemoglobin A1c (HbA1c). After further HbA1c, remained positively 2.15; 1.13-4.08) 1.62; 1.05-2.51), but no longer Subgroup analyses showed that similar results obtained sub-cohort participants without prior diagnosis myocardial infarction stroke. In conclusion, predicts independent HbA1c.

Language: Английский

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Differences in Older Patients' Attitudes Toward Deprescribing at Contextual and Individual Level

Frontiers in Public Health, Journal Year: 2022, Volume and Issue: 10

Published: Feb. 11, 2022

Background Deprescribing requires patients' involvement and taking attitudes toward deprescribing into account. To understand the observed variation in these attitudes, influence of contextual-level factors, such as country or healthcare setting, should be taken Methods We conducted a systematic review studies using revised Patients' Attitudes Towards (rPATD) questionnaire among older adults. searched articles Medline Embase up to 30 June 2021. PRISMA guideline was used for search process reporting. summarized outcomes from rPATD compared at study population level between high low-middle-income countries, global regions, settings ANOVA testing. Correlations with mean age populations were tested. Associations individual patient extracted included summarized. Results Sixteen included. Percentages patients willing stop medication significantly lower countries (<70% Nepal Malaysia) high-income (>85% USA, Australia, European countries). No significant differences when results by region setting but willingness (>95%) seen two an inpatient population. A higher associated medication. At level, associations characteristics, including demographics education, showed inconsistent results. Conclusion Findings about are influenced contextual factors. Future research pay more attention system well culture on attitudes.

Language: Английский

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Cost-effectiveness of a medication review intervention for general practitioners and their multimorbid older patients with polypharmacy

Socio-Economic Planning Sciences, Journal Year: 2024, Volume and Issue: 92, P. 101837 - 101837

Published: Feb. 2, 2024

Older adults with multiple chronic conditions and polypharmacy are at an increased risk of having adverse health outcomes, affecting quality life generating costs. Primary care has to be effective guarantee excellent treatment these patients, who among the most vulnerable. This project aimed assess cost-effectiveness a tool improving general practitioners' (GPs) performance, namely medication review intervention centered around electronic clinical decision support system (eCDSS). We performed pre-planned within-trial analysis OPTICA trial, cluster randomized controlled trial in Swiss primary practices optimizing appropriateness reducing prescribing omissions. Trial participants were older aged ≥65 years ≥3 ≥5 medications. The 160 group received eCDSS provided by their GP followed shared decision-making GP. 163 control had discussion line usual Patients followed-up for 12 months. Considering clustered structure data practice level, we applied Generalized Structural Equation Models (GSEMs) on imputed sample estimate effects costs quality-adjusted (QALYs). strategy was dominant cost-savings CHF 1′857 (95 % confidence interval (CI): -3′620 −93, p-value <0.039, 1≅USD 1.11 as November 2023) gain 0.026 incremental QALYs CI: 0.013 0.040, <0.001) per study participant. In robustness analyses, directions fully consistent, albeit some effect estimates non-significant. Subgroup analyses suggested stronger men 65–74 or ≥85 years. led cost savings improvement life, potentially resulting from accumulation small positive effects, such fewer hospitalizations nursing visits home.

Language: Английский

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A mixed methods analysis of the medication review intervention centered around the use of the ‘Systematic Tool to Reduce Inappropriate Prescribing’ Assistant (STRIPA) in Swiss primary care practices

BMC Health Services Research, Journal Year: 2024, Volume and Issue: 24(1)

Published: March 18, 2024

Abstract Background Electronic clinical decision support systems (eCDSS), such as the ‘Systematic Tool to Reduce Inappropriate Prescribing’ Assistant (STRIPA), have become promising tools for assisting general practitioners (GPs) with conducting medication reviews in older adults. Little is known about how GPs perceive eCDSS-assisted recommendations pharmacotherapy optimization. The aim of this study was explore implementation a review intervention centered around STRIPA ‘Optimising PharmacoTherapy In multimorbid elderly primary CAre’ (OPTICA) trial. Methods We used an explanatory mixed methods design combining quantitative and qualitative data. First, data acceptance eCDSS-generated from ( n = 21) their patients 160) OPTICA group were collected. Then, semi-structured interviews conducted 8), interview analyzed through thematic analysis. Results findings, reported averages 13 min spent per patient preparing eCDSS, 10 performing reviews, 5 discussing prescribing patients. On average, out mean generated 3.7 (SD=1.8). One recommendation stop or start be implemented (SD=1.2). Overall, found useful acceptable. They particularly appreciated its ability generate based on large amounts information. During interviews, main reasons limited related problems sourcing (e.g., incomplete imports), preparation eCDSS time expenditure updating adapting information), functionality technical downloading PDF reports), appropriateness recommendations. Conclusions Qualitative findings help explain relatively low demonstrated by but also show GPs’ overall STRIPA. Our results provide crucial insights make it more suitable regular use future care settings necessity improve imports). Trial registration Clinicaltrials.gov NCT03724539, date first registration: 29/10/2018.

Language: Английский

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Developing and testing a framework for coding general practitioners’ free-text diagnoses in electronic medical records - a reliability study for generating training data in natural language processing

BMC Primary Care, Journal Year: 2024, Volume and Issue: 25(1)

Published: July 16, 2024

Diagnoses entered by general practitioners into electronic medical records have great potential for research and practice, but unfortunately, diagnoses are often in uncoded format, making them of little use. Natural language processing (NLP) could assist coding free-text diagnoses, NLP models require local training data to unlock their potential. The aim this study was develop a framework research-relevant diagnostic codes, test the using from Swiss primary care database generate modelling.

Language: Английский

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Postprandial Plasma Glucose between 4 and 7.9 Hours May Be a Potential Diagnostic Marker for Diabetes

Published: April 15, 2024

Postprandial glucose levels between 4 and 7.9 hours (PPG4–7.9h) correlate with mortality from various diseases including hypertension, diabetes, cardiovascular disease, cancer. This study aimed to assess if predicted PPG4–7.9h could diagnose diabetes. Two groups of participants were involved: Group 1 (4420 participants) had actual PPG4–7.9h, while 2 (8422 lacked this measure but all the diabetes diagnostic measures. underwent multiple linear regression predict using 30 predictors, achieving accuracy within 11.1 mg/dL in 80% participants. model. Receiver operating characteristic curve analysis showed that an 87.3% 2, a sensitivity 75.1% specificity 84.1% at optimal cutoff 102.5 mg/dL. Simulation on 10,000 random samples revealed 175 may be needed investigate as marker power least 80%. In conclusion, appears promising indicator for Future studies seeking ascertain its definitive value might require minimum sample size

Language: Английский

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