Changes in prescribed medicines in older patients with multimorbidity and polypharmacy in general practice.
Autor: | von Buedingen F; Institute of General Practice, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Main, Germany., Hammer MS; Institute of General Practice, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Main, Germany., Meid AD; Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany., Müller WE; Pharmacological Institute for Natural Scientists, Johann Wolfgang Goethe University, Max-von-Laue-Str. 9, 60438, Frankfurt am Main, Germany., Gerlach FM; Institute of General Practice, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Main, Germany., Muth C; Institute of General Practice, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Main, Germany. muth@allgemeinmedizin.uni-frankfurt.de. |
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Jazyk: | angličtina |
Zdroj: | BMC family practice [BMC Fam Pract] 2018 Jul 28; Vol. 19 (1), pp. 131. Date of Electronic Publication: 2018 Jul 28. |
DOI: | 10.1186/s12875-018-0825-3 |
Abstrakt: | 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: ∆ 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 ∆ 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. |
Databáze: | MEDLINE |
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