Acceptability of patient-centered, multi-disciplinary medication therapy management recommendations: results from the INCREASE randomized study.

Autor: Smith NI; University of Kentucky College of Pharmacy, Lexington, KY, USA., Martinez AI; Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA., Huffmyer M; University of Kentucky College of Pharmacy, Lexington, KY, USA.; University of Kentucky Healthcare, Lexington, KY, USA.; LLC Consulting Services, Lexington, KY, PRO2RX, USA., Eckmann L; LLC Consulting Services, Lexington, KY, PRO2RX, USA., George R; Sanders-Brown Center On Aging, University of Kentucky, Lexington, KY, USA., Abner EL; Sanders-Brown Center On Aging, University of Kentucky, Lexington, KY, USA.; University of Kentucky College of Public Health, Lexington, KY, USA., Jicha GA; Sanders-Brown Center On Aging, University of Kentucky, Lexington, KY, USA.; University of Kentucky College of Medicine, 789 S Limestone, Lexington, KY, 40536, USA., Moga DC; University of Kentucky College of Pharmacy, Lexington, KY, USA. daniela.moga@uky.edu.; Sanders-Brown Center On Aging, University of Kentucky, Lexington, KY, USA. daniela.moga@uky.edu.; University of Kentucky College of Public Health, Lexington, KY, USA. daniela.moga@uky.edu.
Jazyk: angličtina
Zdroj: BMC geriatrics [BMC Geriatr] 2023 Mar 10; Vol. 23 (1), pp. 137. Date of Electronic Publication: 2023 Mar 10.
DOI: 10.1186/s12877-023-03876-4
Abstrakt: Background: Polypharmacy and inappropriate medications may be a modifiable risk factor for Alzheimer's Disease and Related Dementias (ADRD). Medication therapy management (MTM) interventions may mitigate medication-induced cognitive dysfunction and delay onset of symptomatic impairment. The objective of the current study is to describe an MTM protocol for a patient-centered team intervention (pharmacist and non-pharmacist clinician) in a randomized controlled trial (RCT) directed at delaying the symptomatic onset of ADRD.
Methods: Community dwelling adults 65 + years, non-demented, using ≥ 1 potentially inappropriate medications (PIM) were enrolled in an RCT to evaluate the effect of an MTM intervention on improving medication appropriateness and cognition (NCT02849639). The MTM intervention involved a three-step process: (1) pharmacist identified potential medication-related problems (MRPs) and made initial recommendations for prescribed and over-the-counter medications, vitamins, and supplements; (2) study team reviewed all initial recommendations together with the participants, allowing for revisions prior to the finalized recommendations; (3) participant responses to final recommendations were recorded. Here, we describe initial recommendations, changes during team engagement, and participant responses to final recommendations.
Results: Among the 90 participants, a mean 6.7 ± 3.6 MRPs per participant were reported. Of the 259 initial MTM recommendations made for the treatment group participants (N = 46), 40% percent underwent revisions in the second step. Participants reported willingness to adopt 46% of final recommendations and expressed need for additional primary care input in response to 38% of final recommendations. Willingness to adopt final recommendations was highest when therapeutic switches were offered and/or with anticholinergic medications.
Conclusion: The evaluation of modifications to MTM recommendations demonstrated that pharmacists' initial MTM recommendations often changed following the participation in the multidisciplinary decision-making process that incorporated patient preferences. The team was encouraged to see a correlation between engaging patients and a positive overall response towards participant acceptance of final MTM recommendations.
Trial Registration: Study registration number: clinicaltrial.gov NCT02849639 registered on 29/07/2016.
(© 2023. The Author(s).)
Databáze: MEDLINE
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