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: Cura-González, Isabel del, López-Rodríguez, Juan A., Leiva-Fernández, Francisca, Gimeno-Miguel, Antonio, Poblador-Plou, Beatriz, López-Verde, Fernando, Lozano-Hernández, Cristina, Pico-Soler, Victoria, Bujalance-Zafra, María 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: artículo
Estado:Versión publicada
Fecha de publicación:2022
País:España
Recursos:Universidad de Zaragoza
Repositorio:Zaguán. Repositorio Digital de la Universidad de Zaragoza
OAI Identifier:oai:zaguan.unizar.es:151054
Acesso em linha:http://zaguan.unizar.es/record/151054
Access Level:acceso abierto
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spelling How to Improve Healthcare for Patients with Multimorbidity and Polypharmacy in Primary Care: A Pragmatic Cluster-Randomized Clinical Trial of the MULTIPAP InterventionCura-González, Isabel delLópez-Rodríguez, Juan A.Leiva-Fernández, FranciscaGimeno-Miguel, AntonioPoblador-Plou, BeatrizLópez-Verde, FernandoLozano-Hernández, CristinaPico-Soler, VictoriaBujalance-Zafra, María JosefaGimeno-Feliu, Luis A.Aza-Pascual-salcedo, MercedesRogero-Blanco, MarisaGonzález-Rubio, FranciscaGarcía-De-blas, FranciscaPolentinos-Castro, ElenaSanz-Cuesta, TeresaCastillo Jimena, MarcosAlonso-García, MarcosCalderón-Larrañaga, AmaiaValderas, José M.Marengoni, AlessandraMuth, ChristianePrados-Torres, Juan DanielPrados-Torres, Alexandra(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. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.2022info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttp://zaguan.unizar.es/record/151054reponame:Zaguán. Repositorio Digital de la Universidad de Zaragozainstname:Universidad de ZaragozaInglésinfo:eu-repo/grantAgreement/ES/ISCIII/FISinfo:eu-repo/grantAgreement/ES/ISCIII/FISinfo:eu-repo/grantAgreement/ES/ISCIII/FISinfo:eu-repo/grantAgreement/ES/ISCIII/RD16-0001-0004info:eu-repo/grantAgreement/ES/ISCIII/RD16-0001-0005info:eu-repo/grantAgreement/ES/ISCIII/RD16-0001-0006info:eu-repo/semantics/openAccessoai:zaguan.unizar.es:1510542026-05-29T13:59:51Z
dc.title.none.fl_str_mv 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
spellingShingle How to Improve Healthcare for Patients with Multimorbidity and Polypharmacy in Primary Care: A Pragmatic Cluster-Randomized Clinical Trial of the MULTIPAP Intervention
Cura-González, Isabel del
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_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_sort How to Improve Healthcare for Patients with Multimorbidity and Polypharmacy in Primary Care: A Pragmatic Cluster-Randomized Clinical Trial of the MULTIPAP Intervention
dc.creator.none.fl_str_mv Cura-González, Isabel del
López-Rodríguez, Juan A.
Leiva-Fernández, Francisca
Gimeno-Miguel, Antonio
Poblador-Plou, Beatriz
López-Verde, Fernando
Lozano-Hernández, Cristina
Pico-Soler, Victoria
Bujalance-Zafra, María 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 Cura-González, Isabel del
author_facet Cura-González, Isabel del
López-Rodríguez, Juan A.
Leiva-Fernández, Francisca
Gimeno-Miguel, Antonio
Poblador-Plou, Beatriz
López-Verde, Fernando
Lozano-Hernández, Cristina
Pico-Soler, Victoria
Bujalance-Zafra, María 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_role author
author2 López-Rodríguez, Juan A.
Leiva-Fernández, Francisca
Gimeno-Miguel, Antonio
Poblador-Plou, Beatriz
López-Verde, Fernando
Lozano-Hernández, Cristina
Pico-Soler, Victoria
Bujalance-Zafra, María 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
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
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. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.
publishDate 2022
dc.date.none.fl_str_mv 2022
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dc.identifier.none.fl_str_mv http://zaguan.unizar.es/record/151054
url http://zaguan.unizar.es/record/151054
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
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info:eu-repo/grantAgreement/ES/ISCIII/RD16-0001-0006
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