CTU Bern

Optimising prescribing in older adults with multimorbidity and polypharmacy in primary care

06.06.2023 – Hospital readmissions are frequent, costly, and sometimes preventable but the best interventions for reducing them remain unclear. The randomized controlled trial TARGET-READ assessed whether a multimodal transitional care intervention would reduce hospital readmission in patients at a high risk for readmission.

The Optimising PharmacoTherapy In the multimorbid elderly in primary CAre (OPTICA) trial studied the effects of a primary care medication review intervention in older adults with multimorbidity and polypharmacy. Final results are now presented in the BMJ.

Patients with multiple chronic conditions and polypharmacy are at an increased risk of inappropriate prescribing or prescribing omissions. Inappropriate polypharmacy in older adults is a major driver of healthcare related harm as this population is at increased risk for adverse drug effects, falls, or functional decline in activities of daily living.

In this cluster randomised clinical trial, 43 general practitioners and 323 patients were recruited. A medication review intervention centred around an electronic clinical decision support system (eCDSS) was compared with a discussion about medication in line with usual care to investigate its effect on appropriateness of prescribed medications and the number of prescribing omissions. On average, one recommendation to stop or start a medication was actually implemented. At 12 months, the results of the intention-to-treat analysis of the improvement in appropriateness of medication (odds ratio 1.05, 95% confidence interval 0.59 to 1.87) and the number of prescribing omissions (0.90, 0.41 to 1.96) were inconclusive. Nevertheless, the intervention could be safely delivered without causing any harm to patients.

CTU Bern was involved in the planning, data management, monitoring, and statistical analysis of the trial.

Please find the publication here: https://www.bmj.com/content/381/bmj-2022-074054