Evidence map›Paper›PMID 29362248›Full record

Trial reportBMJ open2018

Narrative medicine-based intervention in primary care to reduce polypharmacy: results from the cluster-randomised controlled trial MultiCare AGENDA.

Ingmar Schäfer, Hanna Kaduszkiewicz, Christine Mellert, Christin Löffler, Achim Mortsiefer, Annette Ernst, Carl-Otto Stolzenbach, Birgitt Wiese, Heinz-Harald Abholz, Martin Scherer and 2 more

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

Trial report in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
23citing papers in PubMed, 6 pooled it
2.3field-weighted citation impact, top 12% 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

23 citing papers in PubMed, 6 syntheses or guidelines pooled it, 40 citations in OpenAlex.

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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

12 authors at 6 institutions in 1 country.

Ingmar SchäferDepartment of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Hanna KaduszkiewiczMedical Faculty, Institute of General Practice, University of Kiel, Kiel, Germany.
Christine MellertFaculty of Medicine, Institute of General Practice, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
Christin LöfflerInstitute of General Practice, Rostock University Medical Center, Rostock, Germany.
Achim MortsieferFaculty of Medicine, Institute of General Practice, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
Annette ErnstDepartment of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Carl-Otto StolzenbachDepartment of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Birgitt WieseInstitute for General Practice, Hannover Medical School, Hannover, Germany.
Heinz-Harald AbholzFaculty of Medicine, Institute of General Practice, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
Martin SchererDepartment of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Hendrik van den BusscheDepartment of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Attila AltinerInstitute of General Practice, Rostock University Medical Center, Rostock, Germany.
Heinrich Heine University Düsseldorf · DEUniversität Hamburg · DEUniversity Medical Center Hamburg-Eppendorf · DEUniversity of Rostock · DEChristian-Albrechts-Universität zu Kiel · DEMedizinische Hochschule Hannover · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo determine if patient-centred communication leads to a reduction of the number of medications taken without reducing health-related quality of life.

designTwo-arm cluster-randomised controlled trial.

setting55 primary care practices in Hamburg, Düsseldorf and Rostock, Germany.

participants604 patients 65 to 84 years of age with at least three chronic conditions.

interventionsWithin the 12-month intervention, general practitioners (GPs) had three 30 min talks with each of their patients in addition to routine consultations. The first talk aimed at identifying treatment targets and priorities of the patient. During the second talk, the medication taken by the patient was discussed based on a 'brown bag' review of all the medications the patient had at home. The third talk served to discuss goal attainment and future treatment targets. GPs in the control group performed care as usual. PRIMARY OUTCOME MEASURES: We assumed that the number of medications taken by the patient would be reduced by 1.5 substances in the intervention group and that the change in the intervention group's health-related quality of life would not be statistically significantly inferior to the control group.

resultsThe patients took a mean of 7.0±3.5 medications at baseline and 6.8±3.5 medications at follow-up. There was no difference between treatment and control group in the change of the number of medications taken (0.43; 95% CI -0.07 to 0.93; P=0.094) and no difference in health-related quality of life (0.03; -0.02 to 0.08; P=0.207). The likelihood of receiving a new prescription for analgesics was twice as high in the intervention group compared with the control group (risk ratio, 2.043; P=0.019), but the days spent in hospital were reduced by the intervention (-3.07; -5.25 to -0.89; P=0.006).

conclusionsIntensifying the doctor-patient dialogue and discussing the patient's agenda and personal needs did not lead to a reduction of medication intake and did not alter health-related quality of life. TRIAL REGISTRATION NUMBER: ISRCTN46272088; Pre-results.

Indexed as

Narrative MedicinePolypharmacyReferral and ConsultationAgedChronic DiseaseDrug UtilizationFemaleGeneral PracticeGermanyHumansLogistic ModelsMaleMultimorbidityPhysician-Patient RelationsPrimary Health CareQuality of Lifechronic care modelmultimorbiditynarrative based medicinepolypharmacy

Identifiers

PMID29362248
PMCPMC5786138
OpenAlexW2798051571

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
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.