Evidence map›Paper›PMID 29478012›Full record

Trial reportBMJ open2018

Effectiveness of a complex intervention on Prioritising Multimedication in Multimorbidity (PRIMUM) in primary care: results of a pragmatic cluster randomised controlled trial.

Christiane Muth, Lorenz Uhlmann, Walter E Haefeli, Justine Rochon, Marjan van den Akker, Rafael Perera, Corina Güthlin, Martin Beyer, Frank Oswald, Jose Maria Valderas and 3 more

Registry-linked trialOpen access · goldAbstract readPragmatic Clinical 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. It is linked to trial NCT01171339 (Prioritising and Optimising Multiple Medications in Elderly Multimorbid Patients in General Practice. - A Pragmatic Cluster-randomised Controlled Trial.), which is not on this map. Cited by 61 papers, 14 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
61citing papers in PubMed, 14 pooled it
8.1field-weighted citation impact, top 2% 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.

NCT01171339 nacompletednot on this map

Prioritising and Optimising Multiple Medications in Elderly Multimorbid Patients in General Practice. - A Pragmatic Cluster-randomised Controlled Trial.

TypeinterventionalSponsorGoethe UniversityRan2010 to 2012Enrolled505ConditionsChronic DiseaseArmsOptimization strategy (complex intervention)
3 · Its place in the literature

Who cites it

61 citing papers in PubMed, 14 syntheses or guidelines pooled it, 104 citations in OpenAlex.

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  2. Patient and family engagement interventions in primary care patient safety: systematic review and meta-analysis of randomised controlled trials.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025
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  7. 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
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1 more citing papers are in PubMed but not listed here.

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

13 authors at 6 institutions in 4 countries.

Christiane MuthInstitute of General Practice, Johann Wolfgang Goethe University, Frankfurt, Germany.
Lorenz UhlmannInstitute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
Walter E HaefeliDepartment of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany.
Justine RochonInstitute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
Marjan van den AkkerDepartment of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands.
Rafael PereraNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Corina GüthlinInstitute of General Practice, Johann Wolfgang Goethe University, Frankfurt, Germany.
Martin BeyerInstitute of General Practice, Johann Wolfgang Goethe University, Frankfurt, Germany.
Frank OswaldInterdisciplinary Ageing Research (IAW), Faculty of Educational Sciences, Johann Wolfgang Goethe University, Frankfurt, Germany.
Jose Maria ValderasAPEx Collaboration for Academic Primary Care, University of Exeter Medical School, Exeter, UK.
J André KnottnerusDepartment of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands.
Ferdinand M GerlachInstitute of General Practice, Johann Wolfgang Goethe University, Frankfurt, Germany.
Sebastian HarderInstitute for Clinical Pharmacology, Johann Wolfgang Goethe University Hospital, Frankfurt / Main, Germany.
Goethe University Frankfurt · DEHeidelberg University · DEMaastricht University · NLUniversity of Exeter · GBUniversity of Oxford · GBZimmer Biomet (Germany) · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesInvestigate the effectiveness of a complex intervention aimed at improving the appropriateness of medication in older patients with multimorbidity in general practice.

designPragmatic, cluster randomised controlled trial with general practice as unit of randomisation.

setting72 general practices in Hesse, Germany.

participants505 randomly sampled, cognitively intact patients (≥60 years, ≥3 chronic conditions under pharmacological treatment, ≥5 long-term drug prescriptions with systemic effects); 465 patients and 71 practices completed the study.

interventionsIntervention group (IG): The healthcare assistant conducted a checklist-based interview with patients on medication-related problems and reconciled their medications. Assisted by a computerised decision support system, the general practitioner optimised medication, discussed it with patients and adjusted it accordingly. The control group (CG) continued with usual care. OUTCOME MEASURES: The primary outcome was a modified Medication Appropriateness Index (MAI, excluding item 10 on cost-effectiveness), assessed in blinded medication reviews and calculated as the difference between baseline and after 6 months; secondary outcomes after 6 and 9 months' follow-up: quality of life, functioning, medication adherence, and so on.

resultsAt baseline, a high proportion of patients had appropriate to mildly inappropriate prescriptions (MAI 0-5 points: n=350 patients). Randomisation revealed balanced groups (IG: 36 practices/252 patients; CG: 36/253). Intervention had no significant effect on primary outcome: mean MAI sum scores decreased by 0.3 points in IG and 0.8 points in CG, resulting in a non-significant adjusted mean difference of 0.7 (95% CI -0.2 to 1.6) points in favour of CG. Secondary outcomes showed non-significant changes (quality of life slightly improved in IG but continued to decline in CG) or remained stable (functioning, medication adherence).

conclusionsThe intervention had no significant effects. Many patients already received appropriate prescriptions and enjoyed good quality of life and functional status. We can therefore conclude that in our study, there was not enough scope for improvement. TRIAL REGISTRATION NUMBER: ISRCTN99526053. NCT01171339; Results.

Indexed as

Medication ReconciliationPolypharmacyQuality of LifeAgedChronic DiseaseCost-Benefit AnalysisFemaleGeneral PracticeGermanyHumansMaleMedication AdherenceMiddle AgedMultimorbidityPrimary Health CareSeverity of Illness Indexcomputer-assisted drug therapyMedication Appropriateness Indexmedication reconciliationmultimorbiditymultiple chronic conditionspolypharmacy

Identifiers

PMID29478012
PMCPMC5855483
OpenAlexW2799864530

What OpenQuestion holds

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LicenceCC BY-NC
Read underepoch 390

Registered trials

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.