Team approach to polypharmacy evaluation and reduction: feasibility randomized trial of a structured clinical pathway to reduce polypharmacy
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 reduc...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-05-01
|
| Series: | Pilot and Feasibility Studies |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40814-023-01315-0 |
| _version_ | 1797823003537440768 |
|---|---|
| author | 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 |
| author_facet | 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 |
| author_sort | Dee Mangin |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-13T10:17:26Z |
| format | Article |
| id | doaj.art-32e23d8eb27d4ec38e1ef1f64e7dbd29 |
| institution | Directory Open Access Journal |
| issn | 2055-5784 |
| language | English |
| last_indexed | 2024-03-13T10:17:26Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Pilot and Feasibility Studies |
| spelling | doaj.art-32e23d8eb27d4ec38e1ef1f64e7dbd292023-05-21T11:09:06ZengBMCPilot and Feasibility Studies2055-57842023-05-019111910.1186/s40814-023-01315-0Team approach to polypharmacy evaluation and reduction: feasibility randomized trial of a structured clinical pathway to reduce polypharmacyDee Mangin0Larkin Lamarche1Gina Agarwal2Abbas Ali3Alan Cassels4Kiska Colwill5Lisa Dolovich6Naomi Dore Brown7Barbara Farrell8Karla Freeman9Kristina Frizzle10Scott R. Garrison11James Gillett12Anne Holbrook13Jane Jurcic-Vrataric14James McCormack15Jenna Parascandalo16Julie Richardson17Cathy Risdon18Diana Sherifali19Henry Siu20Sayem Borhan21Jeffery A. Templeton22Lehana Thabane23Johanna Trimble24Department of Family Medicine, David Braley Health Sciences Centre, McMaster UniversityDepartment of Family Medicine, David Braley Health Sciences Centre, McMaster UniversityDepartment of Family Medicine, David Braley Health Sciences Centre, McMaster UniversityDepartment of Family Medicine, David Braley Health Sciences Centre, McMaster UniversityUniversity of VictoriaDepartment of Family Medicine, David Braley Health Sciences Centre, McMaster UniversityDepartment of Family Medicine, David Braley Health Sciences Centre, McMaster UniversityDepartment of Family Medicine, David Braley Health Sciences Centre, McMaster UniversityBruyère Research InstituteDepartment of Family Medicine, David Braley Health Sciences Centre, McMaster UniversityDepartment of Family Medicine, David Braley Health Sciences Centre, McMaster UniversityUniversity of Alberta, 6-60 University TerraceDepartment of Family Medicine, David Braley Health Sciences Centre, McMaster UniversityDepartment of Family Medicine, David Braley Health Sciences Centre, McMaster UniversityDepartment of Family Medicine, David Braley Health Sciences Centre, McMaster UniversityUniversity of British ColumbiaDepartment of Family Medicine, David Braley Health Sciences Centre, McMaster UniversityDepartment of Family Medicine, David Braley Health Sciences Centre, McMaster UniversityDepartment of Family Medicine, David Braley Health Sciences Centre, McMaster UniversityDepartment of Family Medicine, David Braley Health Sciences Centre, McMaster UniversityDepartment of Family Medicine, David Braley Health Sciences Centre, McMaster UniversityDepartment of Family Medicine, David Braley Health Sciences Centre, McMaster UniversityDepartment of Family Medicine, David Braley Health Sciences Centre, McMaster UniversityDepartment of Family Medicine, David Braley Health Sciences Centre, McMaster UniversityUniversity of British ColumbiaAbstract 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.https://doi.org/10.1186/s40814-023-01315-0PolypharmacyDeprescribingMulti-morbidityPatient safetyPrimary care |
| spellingShingle | 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 Team approach to polypharmacy evaluation and reduction: feasibility randomized trial of a structured clinical pathway to reduce polypharmacy Pilot and Feasibility Studies Polypharmacy Deprescribing Multi-morbidity Patient safety Primary care |
| title | Team approach to polypharmacy evaluation and reduction: feasibility randomized trial of a structured clinical pathway to reduce polypharmacy |
| title_full | Team approach to polypharmacy evaluation and reduction: feasibility randomized trial of a structured clinical pathway to reduce polypharmacy |
| title_fullStr | Team approach to polypharmacy evaluation and reduction: feasibility randomized trial of a structured clinical pathway to reduce polypharmacy |
| title_full_unstemmed | Team approach to polypharmacy evaluation and reduction: feasibility randomized trial of a structured clinical pathway to reduce polypharmacy |
| title_short | Team approach to polypharmacy evaluation and reduction: feasibility randomized trial of a structured clinical pathway to reduce polypharmacy |
| title_sort | team approach to polypharmacy evaluation and reduction feasibility randomized trial of a structured clinical pathway to reduce polypharmacy |
| topic | Polypharmacy Deprescribing Multi-morbidity Patient safety Primary care |
| url | https://doi.org/10.1186/s40814-023-01315-0 |
| work_keys_str_mv | AT deemangin teamapproachtopolypharmacyevaluationandreductionfeasibilityrandomizedtrialofastructuredclinicalpathwaytoreducepolypharmacy AT larkinlamarche teamapproachtopolypharmacyevaluationandreductionfeasibilityrandomizedtrialofastructuredclinicalpathwaytoreducepolypharmacy AT ginaagarwal teamapproachtopolypharmacyevaluationandreductionfeasibilityrandomizedtrialofastructuredclinicalpathwaytoreducepolypharmacy AT abbasali teamapproachtopolypharmacyevaluationandreductionfeasibilityrandomizedtrialofastructuredclinicalpathwaytoreducepolypharmacy AT alancassels teamapproachtopolypharmacyevaluationandreductionfeasibilityrandomizedtrialofastructuredclinicalpathwaytoreducepolypharmacy AT kiskacolwill teamapproachtopolypharmacyevaluationandreductionfeasibilityrandomizedtrialofastructuredclinicalpathwaytoreducepolypharmacy AT lisadolovich teamapproachtopolypharmacyevaluationandreductionfeasibilityrandomizedtrialofastructuredclinicalpathwaytoreducepolypharmacy AT naomidorebrown teamapproachtopolypharmacyevaluationandreductionfeasibilityrandomizedtrialofastructuredclinicalpathwaytoreducepolypharmacy AT barbarafarrell teamapproachtopolypharmacyevaluationandreductionfeasibilityrandomizedtrialofastructuredclinicalpathwaytoreducepolypharmacy AT karlafreeman teamapproachtopolypharmacyevaluationandreductionfeasibilityrandomizedtrialofastructuredclinicalpathwaytoreducepolypharmacy AT kristinafrizzle teamapproachtopolypharmacyevaluationandreductionfeasibilityrandomizedtrialofastructuredclinicalpathwaytoreducepolypharmacy AT scottrgarrison teamapproachtopolypharmacyevaluationandreductionfeasibilityrandomizedtrialofastructuredclinicalpathwaytoreducepolypharmacy AT jamesgillett teamapproachtopolypharmacyevaluationandreductionfeasibilityrandomizedtrialofastructuredclinicalpathwaytoreducepolypharmacy AT anneholbrook teamapproachtopolypharmacyevaluationandreductionfeasibilityrandomizedtrialofastructuredclinicalpathwaytoreducepolypharmacy AT janejurcicvrataric teamapproachtopolypharmacyevaluationandreductionfeasibilityrandomizedtrialofastructuredclinicalpathwaytoreducepolypharmacy AT jamesmccormack teamapproachtopolypharmacyevaluationandreductionfeasibilityrandomizedtrialofastructuredclinicalpathwaytoreducepolypharmacy AT jennaparascandalo teamapproachtopolypharmacyevaluationandreductionfeasibilityrandomizedtrialofastructuredclinicalpathwaytoreducepolypharmacy AT julierichardson teamapproachtopolypharmacyevaluationandreductionfeasibilityrandomizedtrialofastructuredclinicalpathwaytoreducepolypharmacy AT cathyrisdon teamapproachtopolypharmacyevaluationandreductionfeasibilityrandomizedtrialofastructuredclinicalpathwaytoreducepolypharmacy AT dianasherifali teamapproachtopolypharmacyevaluationandreductionfeasibilityrandomizedtrialofastructuredclinicalpathwaytoreducepolypharmacy AT henrysiu teamapproachtopolypharmacyevaluationandreductionfeasibilityrandomizedtrialofastructuredclinicalpathwaytoreducepolypharmacy AT sayemborhan teamapproachtopolypharmacyevaluationandreductionfeasibilityrandomizedtrialofastructuredclinicalpathwaytoreducepolypharmacy AT jefferyatempleton teamapproachtopolypharmacyevaluationandreductionfeasibilityrandomizedtrialofastructuredclinicalpathwaytoreducepolypharmacy AT lehanathabane teamapproachtopolypharmacyevaluationandreductionfeasibilityrandomizedtrialofastructuredclinicalpathwaytoreducepolypharmacy AT johannatrimble teamapproachtopolypharmacyevaluationandreductionfeasibilityrandomizedtrialofastructuredclinicalpathwaytoreducepolypharmacy |