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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...

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Autores principales: 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
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
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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.
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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
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