Changes in prescribed medicines in older patients with multimorbidity and polypharmacy in general practice
Abstract Background Treatment complexity rises in line with the number of drugs, single doses, and administration methods, thereby threatening patient adherence. Patients with multimorbidity often need flexible, individualised treatment regimens, but alterations during the course of treatment may fu...
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| Format: | Article |
| Language: | English |
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BMC
2018-07-01
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| Series: | BMC Family Practice |
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| Online Access: | http://link.springer.com/article/10.1186/s12875-018-0825-3 |
| _version_ | 1818237268961263616 |
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| author | Fiona von Buedingen Marc S. Hammer Andreas D. Meid Walter E. Müller Ferdinand M. Gerlach Christiane Muth |
| author_facet | Fiona von Buedingen Marc S. Hammer Andreas D. Meid Walter E. Müller Ferdinand M. Gerlach Christiane Muth |
| author_sort | Fiona von Buedingen |
| collection | DOAJ |
| description | Abstract Background Treatment complexity rises in line with the number of drugs, single doses, and administration methods, thereby threatening patient adherence. Patients with multimorbidity often need flexible, individualised treatment regimens, but alterations during the course of treatment may further increase complexity. The objective of our study was to explore medication changes in older patients with multimorbidity and polypharmacy in general practice. Methods We retrospectively analysed data from the cluster-randomised PRIMUM trial (PRIoritisation of MUltimedication in Multimorbidity) conducted in 72 general practices. We developed an algorithm for active pharmaceutical ingredients (API), strength, dosage, and administration method to assess changes in physician-reported medication data during two intervals (baseline to six-months: ∆1; six- to nine-months: ∆2), analysed them descriptively at prescription and patient levels, and checked for intervention effects. Results Of 502 patients (median age 72 years, 52% female), 464 completed the study. Changes occurred in 98.6% of patients (changes were 19% more likely in the intervention group): API changes during ∆1 and ∆2 occurred in 414 (82.5%) and 338 (67.3%) of patients, dosage alterations in 372 (74.1%) and 296 (59.2%), and changes in API strength in 158 (31.5%) and 138 (27.5%) respectively. Administration method changed in 79 (16%) of patients in both ∆1 and ∆2. Simvastatin, metformin and aspirin were most frequently subject to alterations. Conclusion Medication regimens in older patients with multimorbidity and polypharmacy changed frequently. These are mostly due to discontinuations and dosage alterations, followed by additions and restarts. These findings cast doubt on the effectiveness of cross-sectional assessments of medication and support longitudinal assessments where possible. Trial registration. 1. Prospective registration: Trial registration number: NCT01171339; Name of registry: ClinicalTrials.gov; Date of registration: July 27, 2010; Date of enrolment of the first participant to the trial: August 12, 2010. 2. Peer reviewed trial registration: Trial registration number: ISRCTN99526053; Name of registry: Controlled Trials; Date of registration: August 31, 2010; Date of enrolment of the first participant to the trial: August 12, 2010. |
| first_indexed | 2024-12-12T12:23:04Z |
| format | Article |
| id | doaj.art-b3c298a60cd346f784086e1a2fc86872 |
| institution | Directory Open Access Journal |
| issn | 1471-2296 |
| language | English |
| last_indexed | 2024-12-12T12:23:04Z |
| publishDate | 2018-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Family Practice |
| spelling | doaj.art-b3c298a60cd346f784086e1a2fc868722022-12-22T00:24:37ZengBMCBMC Family Practice1471-22962018-07-0119111110.1186/s12875-018-0825-3Changes in prescribed medicines in older patients with multimorbidity and polypharmacy in general practiceFiona von Buedingen0Marc S. Hammer1Andreas D. Meid2Walter E. Müller3Ferdinand M. Gerlach4Christiane Muth5Institute of General Practice, Johann Wolfgang Goethe UniversityInstitute of General Practice, Johann Wolfgang Goethe UniversityDepartment of Clinical Pharmacology and Pharmacoepidemiology, University of HeidelbergPharmacological Institute for Natural Scientists, Johann Wolfgang Goethe UniversityInstitute of General Practice, Johann Wolfgang Goethe UniversityInstitute of General Practice, Johann Wolfgang Goethe UniversityAbstract Background Treatment complexity rises in line with the number of drugs, single doses, and administration methods, thereby threatening patient adherence. Patients with multimorbidity often need flexible, individualised treatment regimens, but alterations during the course of treatment may further increase complexity. The objective of our study was to explore medication changes in older patients with multimorbidity and polypharmacy in general practice. Methods We retrospectively analysed data from the cluster-randomised PRIMUM trial (PRIoritisation of MUltimedication in Multimorbidity) conducted in 72 general practices. We developed an algorithm for active pharmaceutical ingredients (API), strength, dosage, and administration method to assess changes in physician-reported medication data during two intervals (baseline to six-months: ∆1; six- to nine-months: ∆2), analysed them descriptively at prescription and patient levels, and checked for intervention effects. Results Of 502 patients (median age 72 years, 52% female), 464 completed the study. Changes occurred in 98.6% of patients (changes were 19% more likely in the intervention group): API changes during ∆1 and ∆2 occurred in 414 (82.5%) and 338 (67.3%) of patients, dosage alterations in 372 (74.1%) and 296 (59.2%), and changes in API strength in 158 (31.5%) and 138 (27.5%) respectively. Administration method changed in 79 (16%) of patients in both ∆1 and ∆2. Simvastatin, metformin and aspirin were most frequently subject to alterations. Conclusion Medication regimens in older patients with multimorbidity and polypharmacy changed frequently. These are mostly due to discontinuations and dosage alterations, followed by additions and restarts. These findings cast doubt on the effectiveness of cross-sectional assessments of medication and support longitudinal assessments where possible. Trial registration. 1. Prospective registration: Trial registration number: NCT01171339; Name of registry: ClinicalTrials.gov; Date of registration: July 27, 2010; Date of enrolment of the first participant to the trial: August 12, 2010. 2. Peer reviewed trial registration: Trial registration number: ISRCTN99526053; Name of registry: Controlled Trials; Date of registration: August 31, 2010; Date of enrolment of the first participant to the trial: August 12, 2010.http://link.springer.com/article/10.1186/s12875-018-0825-3Medication changesPolypharmacyOlder adultsGeneral practiceMultiple chronic conditionsMultimorbidity |
| spellingShingle | Fiona von Buedingen Marc S. Hammer Andreas D. Meid Walter E. Müller Ferdinand M. Gerlach Christiane Muth Changes in prescribed medicines in older patients with multimorbidity and polypharmacy in general practice BMC Family Practice Medication changes Polypharmacy Older adults General practice Multiple chronic conditions Multimorbidity |
| title | Changes in prescribed medicines in older patients with multimorbidity and polypharmacy in general practice |
| title_full | Changes in prescribed medicines in older patients with multimorbidity and polypharmacy in general practice |
| title_fullStr | Changes in prescribed medicines in older patients with multimorbidity and polypharmacy in general practice |
| title_full_unstemmed | Changes in prescribed medicines in older patients with multimorbidity and polypharmacy in general practice |
| title_short | Changes in prescribed medicines in older patients with multimorbidity and polypharmacy in general practice |
| title_sort | changes in prescribed medicines in older patients with multimorbidity and polypharmacy in general practice |
| topic | Medication changes Polypharmacy Older adults General practice Multiple chronic conditions Multimorbidity |
| url | http://link.springer.com/article/10.1186/s12875-018-0825-3 |
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