MultiPAP Plus: Improving Prescription in Primary Care Patients With

Status Completed

Clinical Trial Summary

This study assesses the effectiveness of a complex intervention in young-old patients with multimorbidity and polypharmacy aimed at improving physician drug prescription in primary care, measured by hospitalization-mortality at six 6 (T1), 12 (T2) and 18 (T3) months from baseline compared to usual care.

Clinical Trial Description

Design: Pragmatic cluster randomized clinical trial with 18 months follow-up. Unit of randomization: general practitioner. Unit of analysis: patient. Setting: Primary Health Care Centres in three different Spanish Autonomous Communities (Aragón, Madrid and Andalucía). Population: Patients 65-74 years of age with multimorbidity (3 or more chronic diseases) and polypharmacy (5 or more drugs taken for at least three months). N=1234 patients (617 in each arm, 8 patients per physician) will be recruited by general practitioners before randomization. Intervention: Complex intervention incorporating previous MultiPAP intervention (based on the ARIADNE principles with two main components: 1) Training of general practitioners and 2) Patient-centered clinical interview) And it adds a clinical-decision support system to help structured treatment-plan review. Control group: usual care. Variables: First level (Patient): a) Main: hospitalizations and/or mortality; b) Secondary: health services use, quality of life (Euroqol 5D-5L), disability (WHODAS), fractures, pharmacotherapy and adherence to treatment (Morisky-Green), clinical and socio-demographic. Second level (Physician): a) Socio-demographic. b) CDSS use: acceptance and satisfaction of health care provider use c) Professional background: time in the position, center characteristics and medical education involvement. Analysis: All analyses will be carried out adhering to the intention-to-treat principle. Description of baseline characteristics. Basal comparison between groups. Analysis of primary outcome: difference in percentages in the final combined variable from 0 (T0) to 18 months (T3), with its corresponding 95% CI. Adjustement by main confounding and prognostic factors will be performed through a multilevel analysis. ;

Study Design

Related Conditions & MeSH terms

Clinical Decision-Support Systems
Comorbidities and Coexisting Conditions
Multimorbidity
Polypharmacy

Clinical Trial Details

NCT number	NCT04147130
Study type	Interventional
Source	Instituto Aragones de Ciencias de la Salud
Contact
Status	Completed
Phase	N/A
Start date	February 18, 2020
Completion date	December 26, 2023

View Details

See also
Status	Clinical Trial	Phase
Completed	`NCT03688542` - Opportunities and Limits to Deprescribing in Nursing Homes:Quality Circle Deprescribing Module	N/A
Completed	`NCT02545257` - Development of a Coordinated, Community-Based Medication Management Model for Home-Dwelling Aged in Primary Care	N/A
Withdrawn	`NCT01932632` - Medication Minimization for Long-term Care Residents	N/A
Recruiting	`NCT04615065` - Acutelines: a Large Data-/Biobank of Acute and Emergency Medicine
Active, not recruiting	`NCT04181879` - Appropriate Polypharmacy in Older People in Primary Care	N/A
Not yet recruiting	`NCT03283735` - Deprescribing: a Portrait and Out-comes of the Reduction of Polypharmacy in Portugal	N/A
Completed	`NCT02918058` - Reducing Post-discharge Potentially Inappropriate Medications Among Older Adults	N/A
Completed	`NCT03655405` - Randomised, Controlled Trial of an Individual Deprescribing Intervention for Nursing Homes Residents	N/A
Completed	`NCT04575155` - Development & Pilot of the Technology-Enabled Alliance for Medication Therapy Management	N/A
Withdrawn	`NCT05816967` - Rationalisation of Polypharmacy by the RASP-instrument and Discharge Counselling of Geriatric Inpatients	N/A
Completed	`NCT05616689` - Bundled Hyperpolypharmacy Deprescribing	N/A
Terminated	`NCT04055896` - Team Approach to Polypharmacy Evaluation and Reduction in a Long-Term Care Setting	N/A
Active, not recruiting	`NCT03052192` - Biological Aging, Medication, Malnutrition and Inflammation Among Acutely Ill and Healthy Elderly.
Completed	`NCT02866799` - Multi-PAP: Improving Prescription in Primary Care Patients With Multimorbidity and Polypharmacy	N/A
Completed	`NCT01732302` - Educational Intervention to Reduce Drug-related Hospitalizations in Elderly Primary Health Care Patients	N/A
Enrolling by invitation	`NCT05053815` - Pharmacogenomic Testing in a Program of All-inclusive Care for the Elderly (PACE) Setting
Active, not recruiting	`NCT04585191` - Reducing Treatment Risk in Older Adults With Diabetes	N/A
Active, not recruiting	`NCT04120480` - Effectiveness of PGx Testing	N/A
Recruiting	`NCT05609981` - Optimising Medication With Focus on Deprescribing in Frail Older People With Multidose Drug Dispensing Systems	N/A
Recruiting	`NCT05501223` - Physician-initiated Medication Review in a Type 2 Diabetes Outpatient Clinic	N/A

Clinical trials are conducted in a series of steps, called phases - each phase is designed to answer a separate research question.

Phase 1: Researchers test a new drug or treatment in a small group of people for the first time to evaluate its safety, determine a safe dosage range, and identify side effects.
Phase 2: The drug or treatment is given to a larger group of people to see if it is effective and to further evaluate its safety.
Phase 3: The drug or treatment is given to large groups of people to confirm its effectiveness, monitor side effects, compare it to commonly used treatments, and collect information that will allow the drug or treatment to be used safely.
Phase 4: Studies are done after the drug or treatment has been marketed to gather information on the drug's effect in various populations and any side effects associated with long-term use.

MultiPAP Plus: Improving Prescription in Primary Care Patients With Multimorbidity and Polypharmacy — MultiPAP Plus

Clinical Trial Summary

Clinical Trial Description

Study Design

Related Conditions & MeSH terms