Chronic Disease Clinical Trial
Official title:
Prioritising and Optimising Multiple Medications in Elderly Multimorbid Patients in General Practice. - A Pragmatic Cluster-randomised Controlled Trial.
Objective: To investigate whether the complex intervention will improve the appropriateness
of prescriptions in elderly multi-morbid patients with multi-medication in general practices.
Study hypothesis: The primary objective of the study is to determine whether the complex
intervention will improve the appropriateness of prescriptions compared to usual care. The
primary efficacy endpoint is the change in the Medication Appropriateness Index (MAI) score
from baseline (T0) to 6 months after baseline (T1), i.e. the difference MAI T1-T0.
Key elements (1 to 4) of the complex intervention:
1. Basic assessment of medicines that were actually taken (brown bag review) by a general
practice based health care assistant (HCA) and
2. Checklist-based (MediMoL - Medication-Monitoring-List) pre-consultation interview on
problems relating to medicines (technical handling, potential adverse drug reactions)
and patient's therapeutic aims by HCA provides structured information in the
Medication-Monitoring-List (MediMoL) for the general practitioner (GP) and enables
patients to discuss their problems with the GP.
3. GP uses a computerized decision support system (pharmaceutical information system, AiD+)
to optimize medication (reducing number of inappropriate prescriptions, e.g.
pharmaceutical interactions, renal dose adjustments, duplicate prescriptions) and
4. prioritizes medication in the physician-patient consultation taking into consideration
patient's preferences.
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