SEARCHRCTfamily medicine, geriatrics

RCT·family medicine, geriatrics, clinical trial, internal medicine, research methods·PMC10193598

Team approach to polypharmacy evaluation and reduction: feasibility randomized trial of a structured clinical pathway to reduce polypharmacy

Pilot and Feasibility Studies · 25 authors, 7 centres

AI SUMMARY

FIDELITY 100%

POPULATIONPrimary care patients aged 70 years or older taking five or more long-term medications

INTERVENTIONTAPER clinical pathway integrating patient goals with an evidence-based machine screen and TaperMD, including clinical pharmacist and family physician consultations

COMPARISONUsual care, with TAPER offered after 6-month follow-up

This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.

AGENT 01 · STRUCTURED SUMMARY

TRACE TO SOURCE

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TL;DR

This feasibility randomized controlled trial tested the TAPER clinical pathway for reducing polypharmacy in primary care patients aged 70 or older on five or more long-term medications.

Full summary

439 CHARS

This feasibility randomized controlled trial randomized consenting patients aged 70 years or older on five or more long-term medications to TAPER or usual care, with baseline and 6-month assessments. The TAPER intervention uses a pause and monitor drug holiday approach, an evidence-based machine screen, and a web-based system (TaperMD), with patient goals integrated through consultations with a clinical pharmacist and family physician.

PICO

PPOPULATION

Primary care patients aged 70 years or older taking five or more long-term medications

IINTERVENTION

TAPER clinical pathway integrating patient goals with an evidence-based machine screen and TaperMD, including clinical pharmacist and family physician consultations

OOUTCOME

Feasibility across process, resource, management, and scientific domains; primary outcomes were number of prescribed and prescribable medications at 6 months

STUDY TYPE

RCT

SPECIALTY

family medicine

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10193598

Team approach to polypharmacy evaluation and reduction: feasibility randomized trial of a structured clinical pathway to reduce polypharmacy

Pilot and Feasibility Studies

READ THE FULL PAPER

ABSTRACT

Abstract Background Polypharmacy is associated with poorer health outcomes in older adults. Other than the associated multimorbidity, factors contributing to this association could include medication adverse effects and interactions, difficulties in managing complicated medication regimes, and reduced medication adherence. It is unknown how reversible these negative associations may be if polypharmacy is reduced. The purpose of this study was to determine the feasibility of implementing an operationalized clinical pathway aimed to reduce polypharmacy in primary care and to pilot measurement tools suitable for assessing change in health outcomes in a larger randomized controlled trial (RCT). Methods We randomized consenting patients ≥ 70 years old on ≥ 5 long-term medications into intervention or control groups. We collected baseline demographic information and research outcome measures at baseline and 6 months. We assessed four categories of feasibility outcomes: process, resource, management, and scientific. The intervention group received TAPER (team approach to polypharmacy evaluation and reduction), a clinical pathway for reducing polypharmacy using “pause and monitor” drug holiday approach. TAPER integrates patients’ goals, priorities, and preferences with an evidence-based “machine screen” to identify potentially problematic medications and support a tapering and monitoring process, all supported by a web-based system, TaperMD. Patients met with a clinical pharmacist and then with their family physician to finalize a plan for optimization of medications using TaperMD. The control group received usual care and were offered TAPER after follow-up at 6 months. Results All 9 criteria for feasibility were met across the 4 feasibility outcome domains. Of 85 patients screened for eligibility, 39 eligible patients were recruited and randomized; two were excluded post hoc for not meeting the age requirement. Withdrawals (2) and losses to follow-up (3) were small and evenly distributed between arms. Areas for intervention and research process improvement were identified. In general, outcome measures performed well and appeared suitable for assessing change in a larger RCT. Conclusions Results from this feasibility study indicate that TAPER as a clinical pathway is feasible to implement in a primary care team setting and in an RCT research framework. Outcome trends suggest effectiveness. A large-scale RCT will be conducted to investigate the effectiveness of TAPER on reducing polypharmacy and improving health outcomes. Trial registration clinicaltrials.gov NCT02562352 , Registered September 29, 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-023-01315-0. Keywords: Polypharmacy, Deprescribing, Multi-morbidity, Patient safety, Primary care

CITATION EXPORT

Dee Mangin, Larkin Lamarche, Gina Agarwal et al.. Team approach to polypharmacy evaluation and reduction: feasibility randomized trial of a structured clinical pathway to reduce polypharmacy. Pilot and Feasibility Studies. (2023). https://doi.org/10.1186/s40814-023-01315-0

AUTHORS

25 · 7 CENTRES

Dee Mangin, Larkin Lamarche, Gina Agarwal, Abbas Ali, Alan Cassels, Kiska Colwill, Lisa Dolovich, Naomi Dore Brown, Barbara Farrell, Karla Freeman, Kristina Frizzle, Scott R Garrison, James Gillett, Anne Holbrook, Jane Jurcic-Vrataric, James McCormack, Jenna Parascandalo, Julie Richardson, Cathy Risdon, Diana Sherifali, Henry Siu, Sayem Borhan, Jeffery A Templeton, Lehana Thabane, Johanna Trimble

1Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON L8P 1H6 Canada
2Dept. of General Practice, University of Otago, Christchurch, New Zealand
3University of Victoria, 3800 Finnerty Rd, Victoria, BC Canada
4University of Toronto, 144 College Street, Toronto, ON Canada
5Bruyère Research Institute, 43 Bruyère Street, Ottawa, ON Canada
6University of Alberta, 6-60 University Terrace, Edmonton, AB Canada
7University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC Canada