Evidence map›Paper›PMID 34702336›Full record

ArticleTrials2021

Team approach to polypharmacy evaluation and reduction: study protocol for a randomized controlled trial.

Dee Mangin, Larkin Lamarche, Gina Agarwal, Hoan Linh Banh, Naomi Dore Brown, Alan Cassels, Kiska Colwill, Lisa Dolovich, Barbara Farrell, Scott Garrison and 22 more

Registry-linked trialOpen access · goldAbstract readClinical Trial Protocol
PubMed Full text at PMC Publisher
In one paragraph

Article in Trials, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02942927 (Team Approach to Polypharmacy Evaluation and Reduction Randomized Controlled Trial), which is not on this map. Cited by 14 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed, 2 pooled it
3.6field-weighted citation impact, top 6% 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.

NCT02942927 nacompletednot on this map

Team Approach to Polypharmacy Evaluation and Reduction Randomized Controlled Trial

TypeinterventionalSponsorMcMaster UniversityRan2018 to 2025Enrolled345ConditionsMulti-morbidity, Medication Therapy Management, PolypharmacyArmsMedication reduction
3 · Its place in the literature

Who cites it

14 citing papers in PubMed, 2 syntheses or guidelines pooled it, 32 citations in OpenAlex.

  1. 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
    Pooled it
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  12. Polypharmacy and precision medicine.Cambridge prisms. Precision medicine · 2023
    Review
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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

32 authors at 6 institutions in 1 country.

Dee ManginDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada. mangind@mcmaster.ca.ORCID http://orcid.org/0000-0003-2149-9376
Larkin LamarcheDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
Gina AgarwalDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
Hoan Linh BanhUniversity of Alberta, 6-60 University Terrace, Edmonton, Alberta, Canada.
Naomi Dore BrownDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
Alan CasselsUniversity of Victoria, 3800 Finnerty Road, Victoria, BC, Canada.
Kiska ColwillDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
Lisa DolovichDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
Barbara FarrellBruyère Research Institute, 43 Bruyère Street, Ottawa, Ontario, Canada.
Scott GarrisonUniversity of Alberta, 6-60 University Terrace, Edmonton, Alberta, Canada.
James GillettDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
Lauren E GriffithDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
Anne HolbrookDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
Jane Jurcic-VrataricDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
James McCormackUniversity of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, Canada.
Daria O'ReillyDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
Parminder RainaDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
Julie RichardsonDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
Cathy RisdonDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
Mat SavelliDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
Diana SherifaliDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
Henry SiuDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
Jean-Éric TarrideDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
Johanna TrimbleUniversity of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, Canada.
Abbas AliDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
Karla FreemanDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
Jessica LangevinDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
Jenna ParascandaloDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
Jeffrey A TempletonDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
Steven DragosDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
Sayem BorhanDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
Lehana ThabaneDepartment of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
McMaster University · CAUniversity of Alberta · CAUniversity of British Columbia · CABruyère · CAUniversity of Toronto · CAUniversity of Victoria · CA

Funding

CIHR PJT 148971
6 · The paper itself

Abstract

backgroundPolypharmacy in older adults can be associated with negative outcomes including falls, impaired cognition, reduced quality of life, and general and functional decline. It is not clear to what extent these are reversible if the number of medications is reduced. Primary care does not have a systematic approach for reducing inappropriate polypharmacy, and there are few, if any, approaches that account for the patient's priorities and preferences. The primary objective of this study is to test the effect of TAPER (Team Approach to Polypharmacy Evaluation and Reduction), a structured operationalized clinical pathway focused on reducing inappropriate polypharmacy. TAPER integrates evidence tools for identifying potentially inappropriate medications, tapering, and monitoring guidance and explicit elicitation of patient priorities and preferences. We aim to determine the effect of TAPER on the number of medications (primary outcome) and health-related outcomes associated with polypharmacy in older adults.

methodsWe designed a multi-center randomized controlled trial, with the lead implementation site in Hamilton, Ontario. Older adults aged 70 years or older who are on five or more medications will be eligible to participate. A total of 360 participants will be recruited. Participants will be assigned to either the control or intervention arm. The intervention involves a comprehensive multidisciplinary medication review by pharmacists and physicians in partnership with patients. This review will be focused on reducing medication burden, with the assumption that this will reduce the risks and harms of polypharmacy. The control group is a wait list, and control patients will be given appointments for the TAPER intervention at a date after the final outcome assessment. All patients will be followed up and outcomes measured in both groups at baseline and 6 months. DISCUSSION: Our trial is unique in its design in that it aims to introduce an operationalized structured clinical pathway aimed to reduce polypharmacy in a primary care setting while at the same time recording patient's goals and priorities for treatment.

trial registrationClinical Trials.gov NCT02942927. First registered on October 24, 2016.

Indexed as

PolypharmacyQuality of LifeAgedHumansMulticenter Studies as TopicPharmacistsPotentially Inappropriate Medication ListPrimary Health CareRandomized Controlled Trials as TopicReview Literature as TopicDeprescribingHealth outcomesMedication reductionMultimorbidityOlder adultsOperationalized clinical modelOvermedicationPhysician pharmacist collaborationPolypharmacy

Identifiers

PMID34702336
PMCPMC8549321
OpenAlexW3210443626

What OpenQuestion holds

Textmetadata
LicenceCC BY
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.