Improving medication adherence and effective prescribing through a patient-centered prescription model in patients with multimorbidity.

Autor: González-Bueno J; Pharmacy Department, Consorci Hospitalari de Vic, Vic, Barcelona, Spain. javigbueno@gmail.com.; Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain. javigbueno@gmail.com., Sevilla-Sánchez D; Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.; Pharmacy Department, Parc Sanitari Pere Virgili, Barcelona, Spain., Puigoriol-Juvanteny E; Epidemiology Unit, Consorci Hospitalari de Vic, Vic, Barcelona, Spain.; Tissue Repair and Regeneration Laboratory (TR2Lab) Group, Faculty of Sciences and Technology & Faculty of Medicine, University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain., Molist-Brunet N; Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.; Department of Geriatrics, Consorci Hospitalari de Vic & Fundació Hospital de La Santa Creu de Vic, Vic, Barcelona, Spain., Codina-Jané C; Pharmacy Department, Consorci Hospitalari de Vic, Vic, Barcelona, Spain.; Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain., Espaulella-Panicot J; Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain.; Department of Geriatrics, Consorci Hospitalari de Vic & Fundació Hospital de La Santa Creu de Vic, Vic, Barcelona, Spain.
Jazyk: angličtina
Zdroj: European journal of clinical pharmacology [Eur J Clin Pharmacol] 2022 Jan; Vol. 78 (1), pp. 127-137. Date of Electronic Publication: 2021 Aug 27.
DOI: 10.1007/s00228-021-03207-9
Abstrakt: Purpose: This study aimed to assess the impact of the patient-centered prescription (PCP) model in medication adherence and effective prescribing in patients with multimorbidity.
Methods: Uncontrolled before-after study in an intermediate care facility in a mixed urban-rural district. Inpatients aged ≥ 65 years with multimorbidity exposed to polypharmacy before hospital admission were consecutively enrolled. Every patient's treatment plan was analyzed through the PCP model, which includes interventions aimed at improving medication adherence. The primary endpoint was the change in the proportion of adherent patients between pre-admission and after discharge for all regularly scheduled long-term medications, using the proportion of days covered (PDC). Secondary endpoints included the change on mean PDC for all long-term medications, number of long-term medications, proportion of patients with hyperpolypharmacy, medication regimen complexity index (MRCI) score, drug burden index (DBI) score, number of potential inappropriate prescribing (PIP), and proportion of patients with ≥ 2 PIPs.
Results: Ninety-three non-institutionalized patients were included (mean age 83.0 ± SD 6.1 years). The proportion of adherent patients increased from 22.1 to 51.9% (P < 0.001). Intervention also improved mean PDC [mean difference (95% CI) 10.6 (7.7, 13.5)] and effective prescribing through a reduction on the number of long-term medications [- 1.3 (- 1.7, - 0.9)], proportion of patients exposed to hyperpolypharmacy (- 16.1%, P < 0.001), MRCI score [- 2.2 (- 3.4, - 1.0)], DBI score [- 0.16 (- 1.8, - 1.3)], number of PIPs [- 1.6 (- 1.8, - 1.3)], and proportion of patients with ≥ 2 PIPs (- 53.7%, P < 0.001).
Conclusion: Studied intervention provides significant effective prescribing and medication adherence enhancements in non-institutionalized older patients with multimorbidity and polypharmacy.
(© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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