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How to Improve Healthcare for Patients with Multimorbidity and Polypharmacy in Primary Care: A Pragmatic Cluster-Randomized Clinical Trial of the MULTIPAP Intervention

(1) Purpose: To investigate a complex MULTIPAP intervention that implements the Ariadne principles in a primary care population of young-elderly patients with multimorbidity and polypharmacy and to evaluate its effectiveness for improving the appropriateness of prescriptions. (2) Methods: A pragmati...

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Autores principales: del Cura-González, Isabel, López-Rodríguez, Juan A., Leiva-Fernández, Francisca, Gimeno-Miguel, Antonio, Poblador-Plou, Beatriz, López-Verde, Fernando, Lozano-Hernández, Cristina, Pico-Soler, Victoria, Bujalance-Zafra, Mª Josefa, Gimeno-Feliu, Luis A., Aza-Pascual-Salcedo, Mercedes, Rogero-Blanco, Marisa, González-Rubio, Francisca, García-de-Blas, Francisca, Polentinos-Castro, Elena, Sanz-Cuesta, Teresa, Castillo-Jimena, Marcos, Alonso-García, Marcos, Calderón-Larrañaga, Amaia, Valderas, José M., Marengoni, Alessandra, Muth, Christiane, Prados-Torres, Juan Daniel, Prados-Torres, Alexandra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9144280/
https://www.ncbi.nlm.nih.gov/pubmed/35629175
http://dx.doi.org/10.3390/jpm12050752
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author del Cura-González, Isabel
López-Rodríguez, Juan A.
Leiva-Fernández, Francisca
Gimeno-Miguel, Antonio
Poblador-Plou, Beatriz
López-Verde, Fernando
Lozano-Hernández, Cristina
Pico-Soler, Victoria
Bujalance-Zafra, Mª Josefa
Gimeno-Feliu, Luis A.
Aza-Pascual-Salcedo, Mercedes
Rogero-Blanco, Marisa
González-Rubio, Francisca
García-de-Blas, Francisca
Polentinos-Castro, Elena
Sanz-Cuesta, Teresa
Castillo-Jimena, Marcos
Alonso-García, Marcos
Calderón-Larrañaga, Amaia
Valderas, José M.
Marengoni, Alessandra
Muth, Christiane
Prados-Torres, Juan Daniel
Prados-Torres, Alexandra
author_facet del Cura-González, Isabel
López-Rodríguez, Juan A.
Leiva-Fernández, Francisca
Gimeno-Miguel, Antonio
Poblador-Plou, Beatriz
López-Verde, Fernando
Lozano-Hernández, Cristina
Pico-Soler, Victoria
Bujalance-Zafra, Mª Josefa
Gimeno-Feliu, Luis A.
Aza-Pascual-Salcedo, Mercedes
Rogero-Blanco, Marisa
González-Rubio, Francisca
García-de-Blas, Francisca
Polentinos-Castro, Elena
Sanz-Cuesta, Teresa
Castillo-Jimena, Marcos
Alonso-García, Marcos
Calderón-Larrañaga, Amaia
Valderas, José M.
Marengoni, Alessandra
Muth, Christiane
Prados-Torres, Juan Daniel
Prados-Torres, Alexandra
author_sort del Cura-González, Isabel
collection PubMed
description (1) Purpose: To investigate a complex MULTIPAP intervention that implements the Ariadne principles in a primary care population of young-elderly patients with multimorbidity and polypharmacy and to evaluate its effectiveness for improving the appropriateness of prescriptions. (2) Methods: A pragmatic cluster-randomized clinical trial was conducted involving 38 family practices in Spain. Patients aged 65–74 years with multimorbidity and polypharmacy were recruited. Family physicians (FPs) were randomly allocated to continue usual care or to provide the MULTIPAP intervention based on the Ariadne principles with two components: FP training (eMULTIPAP) and FP patient interviews. The primary outcome was the appropriateness of prescribing, measured as the between-group difference in the mean Medication Appropriateness Index (MAI) score change from the baseline to the 6-month follow-up. The secondary outcomes were quality of life (EQ-5D-5 L), patient perceptions of shared decision making (collaboRATE), use of health services, treatment adherence, and incidence of drug adverse events (all at 1 year), using multi-level regression models, with FP as a random effect. (3) Results: We recruited 117 FPs and 593 of their patients. In the intention-to-treat analysis, the between-group difference for the mean MAI score change after a 6-month follow-up was −2.42 (95% CI from −4.27 to −0.59) and, between baseline and a 12-month follow-up was −3.40 (95% CI from −5.45 to −1.34). There were no significant differences in any other secondary outcomes. (4) Conclusions: The MULTIPAP intervention improved medication appropriateness sustainably over the follow-up time. The small magnitude of the effect, however, advises caution in the interpretation of the results given the paucity of evidence for the clinical benefit of the observed change in the MAI. Trial registration: Clinicaltrials.gov NCT02866799.
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spelling pubmed-91442802022-05-29 How to Improve Healthcare for Patients with Multimorbidity and Polypharmacy in Primary Care: A Pragmatic Cluster-Randomized Clinical Trial of the MULTIPAP Intervention del Cura-González, Isabel López-Rodríguez, Juan A. Leiva-Fernández, Francisca Gimeno-Miguel, Antonio Poblador-Plou, Beatriz López-Verde, Fernando Lozano-Hernández, Cristina Pico-Soler, Victoria Bujalance-Zafra, Mª Josefa Gimeno-Feliu, Luis A. Aza-Pascual-Salcedo, Mercedes Rogero-Blanco, Marisa González-Rubio, Francisca García-de-Blas, Francisca Polentinos-Castro, Elena Sanz-Cuesta, Teresa Castillo-Jimena, Marcos Alonso-García, Marcos Calderón-Larrañaga, Amaia Valderas, José M. Marengoni, Alessandra Muth, Christiane Prados-Torres, Juan Daniel Prados-Torres, Alexandra J Pers Med Article (1) Purpose: To investigate a complex MULTIPAP intervention that implements the Ariadne principles in a primary care population of young-elderly patients with multimorbidity and polypharmacy and to evaluate its effectiveness for improving the appropriateness of prescriptions. (2) Methods: A pragmatic cluster-randomized clinical trial was conducted involving 38 family practices in Spain. Patients aged 65–74 years with multimorbidity and polypharmacy were recruited. Family physicians (FPs) were randomly allocated to continue usual care or to provide the MULTIPAP intervention based on the Ariadne principles with two components: FP training (eMULTIPAP) and FP patient interviews. The primary outcome was the appropriateness of prescribing, measured as the between-group difference in the mean Medication Appropriateness Index (MAI) score change from the baseline to the 6-month follow-up. The secondary outcomes were quality of life (EQ-5D-5 L), patient perceptions of shared decision making (collaboRATE), use of health services, treatment adherence, and incidence of drug adverse events (all at 1 year), using multi-level regression models, with FP as a random effect. (3) Results: We recruited 117 FPs and 593 of their patients. In the intention-to-treat analysis, the between-group difference for the mean MAI score change after a 6-month follow-up was −2.42 (95% CI from −4.27 to −0.59) and, between baseline and a 12-month follow-up was −3.40 (95% CI from −5.45 to −1.34). There were no significant differences in any other secondary outcomes. (4) Conclusions: The MULTIPAP intervention improved medication appropriateness sustainably over the follow-up time. The small magnitude of the effect, however, advises caution in the interpretation of the results given the paucity of evidence for the clinical benefit of the observed change in the MAI. Trial registration: Clinicaltrials.gov NCT02866799. MDPI 2022-05-06 /pmc/articles/PMC9144280/ /pubmed/35629175 http://dx.doi.org/10.3390/jpm12050752 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
del Cura-González, Isabel
López-Rodríguez, Juan A.
Leiva-Fernández, Francisca
Gimeno-Miguel, Antonio
Poblador-Plou, Beatriz
López-Verde, Fernando
Lozano-Hernández, Cristina
Pico-Soler, Victoria
Bujalance-Zafra, Mª Josefa
Gimeno-Feliu, Luis A.
Aza-Pascual-Salcedo, Mercedes
Rogero-Blanco, Marisa
González-Rubio, Francisca
García-de-Blas, Francisca
Polentinos-Castro, Elena
Sanz-Cuesta, Teresa
Castillo-Jimena, Marcos
Alonso-García, Marcos
Calderón-Larrañaga, Amaia
Valderas, José M.
Marengoni, Alessandra
Muth, Christiane
Prados-Torres, Juan Daniel
Prados-Torres, Alexandra
How to Improve Healthcare for Patients with Multimorbidity and Polypharmacy in Primary Care: A Pragmatic Cluster-Randomized Clinical Trial of the MULTIPAP Intervention
title How to Improve Healthcare for Patients with Multimorbidity and Polypharmacy in Primary Care: A Pragmatic Cluster-Randomized Clinical Trial of the MULTIPAP Intervention
title_full How to Improve Healthcare for Patients with Multimorbidity and Polypharmacy in Primary Care: A Pragmatic Cluster-Randomized Clinical Trial of the MULTIPAP Intervention
title_fullStr How to Improve Healthcare for Patients with Multimorbidity and Polypharmacy in Primary Care: A Pragmatic Cluster-Randomized Clinical Trial of the MULTIPAP Intervention
title_full_unstemmed How to Improve Healthcare for Patients with Multimorbidity and Polypharmacy in Primary Care: A Pragmatic Cluster-Randomized Clinical Trial of the MULTIPAP Intervention
title_short How to Improve Healthcare for Patients with Multimorbidity and Polypharmacy in Primary Care: A Pragmatic Cluster-Randomized Clinical Trial of the MULTIPAP Intervention
title_sort how to improve healthcare for patients with multimorbidity and polypharmacy in primary care: a pragmatic cluster-randomized clinical trial of the multipap intervention
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9144280/
https://www.ncbi.nlm.nih.gov/pubmed/35629175
http://dx.doi.org/10.3390/jpm12050752
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