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Effects of a comprehensive medication review intervention on health-related quality of life and other clinical outcomes in geriatric outpatients with polypharmacy: A pragmatic randomized clinical trial

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Aim: To investigate the effects of a comprehensive medication review intervention on health-related quality of life (HRQoL) and clinical outcomes in geriatric outpatients exposed to polypharmacy. Methods: Pragmatic, nonblinded, randomized clinical trial with follow-up after 4 and 13 months. Participants were geriatric outpatients taking ≥9 medicines. The intervention was an additional consultation with a physician focusing on reviewing medication, informing patients about their medicines and increasing cross-sectoral communication as supplement to and compared with usual care. The primary outcome was change in HRQoL after 4 months measured with the EuroQoL 5-dimension 5-level (EQ-5D-5L) questionnaire. Secondary outcomes were HRQoL after 13 months, mortality, admissions, falls and number of medicines after 4 and 13 months. Results: Of 785 eligible patients, 408 were included (age: mean 80.6 [standard deviation 7.22] years; number of medicines: median 12 [interquartile range 10–14]; females 71%). After 4 months, the adjusted between-group difference in EQ-5D-5L index score was 0.066 in favour of the medication consultation (95% confidence interval 0.01 to 0.12, P =.02). After 4 months, two (1%) participants had died in the medication-consultation group and nine (4%) in the usual-care group (log-rank test, P =.045). The medication consultation reduced the number of medicines by 2.0 (15.8%) after 4 months and 1.3 (10.7%) after 13 months. There were no statistically significant differences in mortality or HRQoL after 13 months, and no differences in falls or admissions. Conclusions: An additional consultation with medication review and increased communication as supplement to usual geriatric outpatient care improved HRQoL and reduced mortality after 4 months.

OriginalsprogEngelsk
TidsskriftBritish Journal of Clinical Pharmacology
Vol/bind88
Udgave nummer7
Sider (fra-til)3360-3369
Antal sider10
ISSN0306-5251
DOI
StatusUdgivet - jul. 2022

Bibliografisk note

Funding Information:
We would like to thank Ditte-Marie Schärfe Kjærgaard and Linea Fugmann Thamdrup for assistance with data collection. We would like to thank all the physicians, nurses and medical secretaries at the geriatric outpatient clinic at Copenhagen University Hospital, Bispebjerg and Frederiksberg for assistance with the conduct of this study. This work was supported by the Velux Foundation [00025835] and the Capital Region of Denmark [E-12825-01-12-01]. The funders had no role in the design and conduct of the study, the collection, management, analysis and interpretation of the data, the preparation, review or approval of the manuscript or the decision to submit the manuscript for publication.

Funding Information:
We would like to thank Ditte‐Marie Schärfe Kjærgaard and Linea Fugmann Thamdrup for assistance with data collection. We would like to thank all the physicians, nurses and medical secretaries at the geriatric outpatient clinic at Copenhagen University Hospital, Bispebjerg and Frederiksberg for assistance with the conduct of this study. This work was supported by the Velux Foundation [00025835] and the Capital Region of Denmark [E‐12825‐01‐12‐01]. The funders had no role in the design and conduct of the study, the collection, management, analysis and interpretation of the data, the preparation, review or approval of the manuscript or the decision to submit the manuscript for publication.

Publisher Copyright:
© 2022 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.

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