Evidence map›Paper›PMID 28086976›Full record

Trial reportImplementation science : IS2017

Impact of a tailored program on the implementation of evidence-based recommendations for multimorbid patients with polypharmacy in primary care practices-results of a cluster-randomized controlled trial.

Cornelia Jäger, Tobias Freund, Jost Steinhäuser, Christian Stock, Johannes Krisam, Petra Kaufmann-Kolle, Michel Wensing, Joachim Szecsenyi

Open access · goldAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Implementation science : IS, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
24citing papers in PubMed, 10 pooled it
2.4field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

24 citing papers in PubMed, 10 syntheses or guidelines pooled it, 46 citations in OpenAlex.

  1. Tailored interventions to address determinants of practice.The Cochrane database of systematic reviews · 2026
    Pooled it
  2. Pooled it
  3. Influence of health-system change on treatment burden: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2023
    Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Pooled it
  9. Pooled it
  10. Patient-mediated interventions to improve professional practice.The Cochrane database of systematic reviews · 2018
    Pooled it
  11. Trial
  12. Trial
  13. Trial
  14. Review
  15. Multimorbidity Management: A Scoping Review of Interventions and Health Outcomes.International journal of environmental research and public health · 2025
    Article
  16. Observational
  17. Article
  18. Article
  19. Article
  20. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 5 institutions in 1 country.

Cornelia JägerDepartment of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, Turm West, 4.OG, 69120, Heidelberg, Germany. cornelia.jaeger@med.uni-heidelberg.de.
Tobias FreundDepartment of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, Turm West, 4.OG, 69120, Heidelberg, Germany.
Jost SteinhäuserInstitute of Family Medicine, UniversityHospital Schleswig-Holstein, Campus Lübeck, Ratzburger Allee 160, Haus 50, 23538, Lübeck, Germany.
Christian StockDepartment of Medical Biometry, Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, Turm West, 12.OG, 69120, Heidelberg, Germany.
Johannes KrisamDepartment of Medical Biometry, Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, Turm West, 12.OG, 69120, Heidelberg, Germany.
Petra Kaufmann-KolleInstitute for Applied Quality Improvement and Research in Health Care GmbH, (AQUA-Institute), Maschmühlenweg 8-10, 37073, Göttingen, Germany.
Michel WensingDepartment of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, Turm West, 4.OG, 69120, Heidelberg, Germany.
Joachim SzecsenyiDepartment of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, Turm West, 4.OG, 69120, Heidelberg, Germany.
Heidelberg University · DEUniversity Hospital Heidelberg · DEAqua Consult Ingenieur (Germany) · DEUniversity Hospital Schleswig-Holstein · DEZimmer Biomet (Germany) · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMultimorbid patients receiving polypharmacy represent a growing population at high risk for negative health outcomes. Tailoring is an approach of systematic intervention development taking account of previously identified determinants of practice. The aim of this study was to assess the effect of a tailored program to improve the implementation of three important processes of care for this patient group: (a) structured medication counseling including brown bag reviews, (b) the use of medication lists, and (c) structured medication reviews to reduce potentially inappropriate medication.

methodsWe conducted a cluster-randomized controlled trial with a follow-up time of 9 months. Participants were general practitioners (GPs) organized in quality circles and participating in a GP-centered care contract of a German health insurance. Patients aged >50 years, suffering from at least 3 chronic diseases, receiving more than 4 drugs, and being at high risk for medication-related events according to the assessment of the treating GP were enrolled. The tailored program consisted of a workshop for GPs and health care assistants, educational materials and reminders for patients, and the elaboration of implementation action plans. The primary outcome was the change in the degree of implementation between baseline and follow-up, measured by a summary score of 10 indicators. The indicators were based on structured surveys with patients and GPs.

resultsWe analyzed the data of 21 GPs (10 - intervention group, 11 - control group) and 273 patients (130 - intervention group, 143 - control group). The increase in the degree of implementation was 4.2 percentage points (95% confidence interval: -0.3, 8.6) higher in the intervention group compared to the control group (p = 0.1). Two of the 10 indicators were significantly improved in the intervention group: medication counseling (p = 0.017) and brown bag review (p = 0.012). Secondary outcomes showed an effect on patients' self-reported use of medication lists when buying drugs in the pharmacy (p = 0.03).

conclusionsThe tailored program may improve implementation of medication counseling and brown bag review whereas the use of medication lists and medication reviews did not improve. No effect of the tailored program on the combined primary outcome could be substantiated. Due to limitations of the study, results have to be interpreted carefully. The factors facilitating and hindering successful implementation will be examined in a comprehensive process evaluation. TRIAL REGISTRATION NUMBER: ISRCTN34664024 , assigned 14/08/2013.

Indexed as

PolypharmacyAdultAgedChronic DiseaseCluster AnalysisCounselingEvidence-Based MedicineFemaleFollow-Up StudiesGeneral PractitionersGermanyHealth Plan ImplementationHumansInappropriate PrescribingMaleMiddle AgedCommunicationMedication listMedication reviewMultimorbidityPolypharmacyPotentially inappropriate medicationRandomized controlled trialTailoring

Identifiers

PMID28086976
PMCPMC5237147
OpenAlexW2572461031

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.