Older adults' adherence to medications and willingness to deprescribe: A substudy of a randomized clinical trial DOI Creative Commons
Kristie Rebecca Weir, Katharina Tabea Jungo, Sven Streit

и другие.

British Journal of Clinical Pharmacology, Год журнала: 2023, Номер 90(3), С. 905 - 911

Опубликована: Ноя. 13, 2023

Our study investigated the association between patients' willingness to have medications deprescribed and medication adherence. This longitudinal substudy of 'Optimizing PharmacoTherapy In Multimorbid Elderly in Primary CAre' (OPTICA) trial, a cluster randomized controlled took place Swiss primary care settings. Participants were aged ≥65 years over, with ≥3 chronic conditions ≥5 regular medications. At baseline, 'revised Patient Attitudes Towards Deprescribing' (rPATD) questionnaire was measured. The A14-scale measured adherence (self-report) at 12-month follow-up. Multilevel linear regression analyses adjusted for baseline variables performed. Of 298 participants, 45% women, median age 78. reported high level deprescribed. We did not find evidence an deprescribe Further research is needed explore relationship these concepts inform collaborative decisions about medicines context polypharmacy.

Язык: Английский

Optimising prescribing in older adults with multimorbidity and polypharmacy in primary care (OPTICA): cluster randomised clinical trial DOI Creative Commons
Katharina Tabea Jungo,

Anna-Katharina Ansorg,

Carmen Floriani

и другие.

BMJ, Год журнала: 2023, Номер unknown, С. e074054 - e074054

Опубликована: Май 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.

Язык: Английский

Процитировано

23
Older adults’ attitudes towards deprescribing and medication changes: a longitudinal sub-study of a cluster randomised controlled trial DOI Creative Commons
Katharina Tabea Jungo, Kristie Rebecca Weir, Damien Cateau

и другие.

BMJ Open, Год журнала: 2024, Номер 14(1), С. e075325 - e075325

Опубликована: Янв. 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 .

Язык: Английский

Процитировано

6
Cost-effectiveness of a medication review intervention for general practitioners and their multimorbid older patients with polypharmacy DOI Creative Commons
Katharina Tabea Jungo, Paola Salari, Rahel Meier

и другие.

Socio-Economic Planning Sciences, Год журнала: 2024, Номер 92, С. 101837 - 101837

Опубликована: Фев. 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.

Язык: Английский

Процитировано

2
Older adults' adherence to medications and willingness to deprescribe: A substudy of a randomized clinical trial DOI Creative Commons
Kristie Rebecca Weir, Katharina Tabea Jungo, Sven Streit

и другие.

British Journal of Clinical Pharmacology, Год журнала: 2023, Номер 90(3), С. 905 - 911

Опубликована: Ноя. 13, 2023

Our study investigated the association between patients' willingness to have medications deprescribed and medication adherence. This longitudinal substudy of 'Optimizing PharmacoTherapy In Multimorbid Elderly in Primary CAre' (OPTICA) trial, a cluster randomized controlled took place Swiss primary care settings. Participants were aged ≥65 years over, with ≥3 chronic conditions ≥5 regular medications. At baseline, 'revised Patient Attitudes Towards Deprescribing' (rPATD) questionnaire was measured. The A14-scale measured adherence (self-report) at 12-month follow-up. Multilevel linear regression analyses adjusted for baseline variables performed. Of 298 participants, 45% women, median age 78. reported high level deprescribed. We did not find evidence an deprescribe Further research is needed explore relationship these concepts inform collaborative decisions about medicines context polypharmacy.

Язык: Английский

Процитировано

0