Cargando…
Evidence-Based Decision Support for a Structured Care Program on Polypharmacy in Multimorbidity: A Guideline Upgrade Based on a Realist Synthesis
Evidence-based clinical guidelines generally consider single conditions, and rarely multimorbidity. We developed an evidence-based guideline for a structured care program to manage polypharmacy in multimorbidity by using a realist synthesis to update the German polypharmacy guideline including the f...
Autores principales: | , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8778077/ https://www.ncbi.nlm.nih.gov/pubmed/35055383 http://dx.doi.org/10.3390/jpm12010069 |
_version_ | 1784637230906605568 |
---|---|
author | Dinh, Truc Sophia Brueckle, Maria-Sophie González-González, Ana Isabel Fessler, Joachim Marschall, Ursula Schubert-Zsilavesz, Manfred Gerlach, Ferdinand M. Harder, Sebastian van den Akker, Marjan Schubert, Ingrid Muth, Christiane |
author_facet | Dinh, Truc Sophia Brueckle, Maria-Sophie González-González, Ana Isabel Fessler, Joachim Marschall, Ursula Schubert-Zsilavesz, Manfred Gerlach, Ferdinand M. Harder, Sebastian van den Akker, Marjan Schubert, Ingrid Muth, Christiane |
author_sort | Dinh, Truc Sophia |
collection | PubMed |
description | Evidence-based clinical guidelines generally consider single conditions, and rarely multimorbidity. We developed an evidence-based guideline for a structured care program to manage polypharmacy in multimorbidity by using a realist synthesis to update the German polypharmacy guideline including the following five methods: formal prioritization in focus groups; systematic guideline review of evidence-based multimorbidity/polypharmacy guidelines; evidence search/synthesis and recommendation development; multidisciplinary consent of recommendations; feasibility test of updated guideline. We identified the need for a better description of the target group, decision support, prioritization of medication, consideration of patient preferences and anticholinergic properties, and of healthcare interfaces. We conducted a systematic guideline review of eight guidelines and extracted and synthesized recommendations using the Ariadne principles. We also included 48 systematic reviews. We formulated and agreed upon 34 recommendations for the revised guideline. During the feasibility test, guideline use enabled 57% of GPs to identify problems, leading to medication changes in 49% and self-assessed improvement in 56% of patients. Although 58% of GPs felt that it was too long, 92% recommended it. Polypharmacy should be systematically reviewed at least annually. Patients, family members, and healthcare professionals should monitor and adjust it using prospective process validation, taking into account patient preferences and agreed treatment goals. |
format | Online Article Text |
id | pubmed-8778077 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-87780772022-01-22 Evidence-Based Decision Support for a Structured Care Program on Polypharmacy in Multimorbidity: A Guideline Upgrade Based on a Realist Synthesis Dinh, Truc Sophia Brueckle, Maria-Sophie González-González, Ana Isabel Fessler, Joachim Marschall, Ursula Schubert-Zsilavesz, Manfred Gerlach, Ferdinand M. Harder, Sebastian van den Akker, Marjan Schubert, Ingrid Muth, Christiane J Pers Med Article Evidence-based clinical guidelines generally consider single conditions, and rarely multimorbidity. We developed an evidence-based guideline for a structured care program to manage polypharmacy in multimorbidity by using a realist synthesis to update the German polypharmacy guideline including the following five methods: formal prioritization in focus groups; systematic guideline review of evidence-based multimorbidity/polypharmacy guidelines; evidence search/synthesis and recommendation development; multidisciplinary consent of recommendations; feasibility test of updated guideline. We identified the need for a better description of the target group, decision support, prioritization of medication, consideration of patient preferences and anticholinergic properties, and of healthcare interfaces. We conducted a systematic guideline review of eight guidelines and extracted and synthesized recommendations using the Ariadne principles. We also included 48 systematic reviews. We formulated and agreed upon 34 recommendations for the revised guideline. During the feasibility test, guideline use enabled 57% of GPs to identify problems, leading to medication changes in 49% and self-assessed improvement in 56% of patients. Although 58% of GPs felt that it was too long, 92% recommended it. Polypharmacy should be systematically reviewed at least annually. Patients, family members, and healthcare professionals should monitor and adjust it using prospective process validation, taking into account patient preferences and agreed treatment goals. MDPI 2022-01-07 /pmc/articles/PMC8778077/ /pubmed/35055383 http://dx.doi.org/10.3390/jpm12010069 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Dinh, Truc Sophia Brueckle, Maria-Sophie González-González, Ana Isabel Fessler, Joachim Marschall, Ursula Schubert-Zsilavesz, Manfred Gerlach, Ferdinand M. Harder, Sebastian van den Akker, Marjan Schubert, Ingrid Muth, Christiane Evidence-Based Decision Support for a Structured Care Program on Polypharmacy in Multimorbidity: A Guideline Upgrade Based on a Realist Synthesis |
title | Evidence-Based Decision Support for a Structured Care Program on Polypharmacy in Multimorbidity: A Guideline Upgrade Based on a Realist Synthesis |
title_full | Evidence-Based Decision Support for a Structured Care Program on Polypharmacy in Multimorbidity: A Guideline Upgrade Based on a Realist Synthesis |
title_fullStr | Evidence-Based Decision Support for a Structured Care Program on Polypharmacy in Multimorbidity: A Guideline Upgrade Based on a Realist Synthesis |
title_full_unstemmed | Evidence-Based Decision Support for a Structured Care Program on Polypharmacy in Multimorbidity: A Guideline Upgrade Based on a Realist Synthesis |
title_short | Evidence-Based Decision Support for a Structured Care Program on Polypharmacy in Multimorbidity: A Guideline Upgrade Based on a Realist Synthesis |
title_sort | evidence-based decision support for a structured care program on polypharmacy in multimorbidity: a guideline upgrade based on a realist synthesis |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8778077/ https://www.ncbi.nlm.nih.gov/pubmed/35055383 http://dx.doi.org/10.3390/jpm12010069 |
work_keys_str_mv | AT dinhtrucsophia evidencebaseddecisionsupportforastructuredcareprogramonpolypharmacyinmultimorbidityaguidelineupgradebasedonarealistsynthesis AT bruecklemariasophie evidencebaseddecisionsupportforastructuredcareprogramonpolypharmacyinmultimorbidityaguidelineupgradebasedonarealistsynthesis AT gonzalezgonzalezanaisabel evidencebaseddecisionsupportforastructuredcareprogramonpolypharmacyinmultimorbidityaguidelineupgradebasedonarealistsynthesis AT fesslerjoachim evidencebaseddecisionsupportforastructuredcareprogramonpolypharmacyinmultimorbidityaguidelineupgradebasedonarealistsynthesis AT marschallursula evidencebaseddecisionsupportforastructuredcareprogramonpolypharmacyinmultimorbidityaguidelineupgradebasedonarealistsynthesis AT schubertzsilaveszmanfred evidencebaseddecisionsupportforastructuredcareprogramonpolypharmacyinmultimorbidityaguidelineupgradebasedonarealistsynthesis AT gerlachferdinandm evidencebaseddecisionsupportforastructuredcareprogramonpolypharmacyinmultimorbidityaguidelineupgradebasedonarealistsynthesis AT hardersebastian evidencebaseddecisionsupportforastructuredcareprogramonpolypharmacyinmultimorbidityaguidelineupgradebasedonarealistsynthesis AT vandenakkermarjan evidencebaseddecisionsupportforastructuredcareprogramonpolypharmacyinmultimorbidityaguidelineupgradebasedonarealistsynthesis AT schubertingrid evidencebaseddecisionsupportforastructuredcareprogramonpolypharmacyinmultimorbidityaguidelineupgradebasedonarealistsynthesis AT muthchristiane evidencebaseddecisionsupportforastructuredcareprogramonpolypharmacyinmultimorbidityaguidelineupgradebasedonarealistsynthesis AT evidencebaseddecisionsupportforastructuredcareprogramonpolypharmacyinmultimorbidityaguidelineupgradebasedonarealistsynthesis |