Evidence map›Paper›PMID 34814835›Full record

ReviewBMC geriatrics2021

Expert-based medication reviews to reduce polypharmacy in older patients in primary care: a northern-Italian cluster-randomised controlled trial.

Angelika Mahlknecht, Christian J Wiedermann, Marco Sandri, Adolf Engl, Martina Valentini, Anna Vögele, Sara Schmid, Felix Deflorian, Carmelo Montalbano, Dara Koper and 3 more

Open access · goldAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in BMC geriatrics, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 6 pooled it
2.2field-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

18 citing papers in PubMed, 6 syntheses or guidelines pooled it, 30 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

13 authors at 7 institutions in 3 countries.

Angelika MahlknechtInstitute of General Practice and Public Health, College of Health Care Professions, Lorenz Böhler- Street 13, 39100, Bolzano, Italy. angelika.mahlknecht@am-mg.claudiana.bz.it.ORCID 0000-0002-5280-5447
Christian J WiedermannInstitute of General Practice and Public Health, College of Health Care Professions, Lorenz Böhler- Street 13, 39100, Bolzano, Italy.
Marco SandriBig & Open Data Innovation Laboratory (BODaI-Lab), University of Brescia, Via S. Faustino 74/B, 25122, Brescia, Italy.
Adolf EnglInstitute of General Practice and Public Health, College of Health Care Professions, Lorenz Böhler- Street 13, 39100, Bolzano, Italy.
Martina ValentiniSouth Tyrolean Academy of General Practice, Wangergasse 18, 39100, Bolzano, Italy.
Anna VögeleSouth Tyrolean Academy of General Practice, Wangergasse 18, 39100, Bolzano, Italy.
Sara SchmidSouth Tyrolean Academy of General Practice, Wangergasse 18, 39100, Bolzano, Italy.
Felix DeflorianSouth Tyrolean Academy of General Practice, Wangergasse 18, 39100, Bolzano, Italy.
Carmelo MontalbanoGenomedics S.r.L. Health Care Consultants, Via Sestese 61, 50141, Florence, Italy.
Dara KoperSalzburger Gesundheitsfonds, Sebastian Stief-Gasse 2, 5020, Salzburg, Austria.
Romuald BellmannClinical Pharmacokinetics Unit, Division of Medical Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University of Innsbruck, Peter-Anich- Street 35, 6020, Innsbruck, Austria.
Andreas SönnichsenDepartment of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/I, 1090, Vienna, Austria.
Giuliano PiccolioriInstitute of General Practice and Public Health, College of Health Care Professions, Lorenz Böhler- Street 13, 39100, Bolzano, Italy.
Eurac Research · ITAzienda Ospedaliero-Universitaria Careggi · ITInnsbruck Medical University · ATMedical University of Vienna · ATParacelsus Medical University · ATUMIT - Private Universität für Gesundheitswissenschaften, Medizinische Informatik und Technik · ATUniversity of Brescia · IT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEvidence regarding clinically relevant effects of interventions aiming at reducing polypharmacy is weak, especially for the primary care setting. This study was initiated with the objective to achieve clinical benefits for older patients (aged 75+) by means of evidence-based reduction of polypharmacy (defined as ≥8 prescribed drugs) and inappropriate prescribing in general practice.

methodsThe cluster-randomised controlled trial involved general practitioners and patients in a northern-Italian region. The intervention consisted of a review of patient's medication regimens by three experts who gave specific recommendations for drug discontinuation. Main outcome measures were non-elective hospital admissions or death within 24 months (composite primary endpoint). Secondary outcomes were drug numbers, hospital admissions, mortality, falls, fractures, quality of life, affective status, cognitive function.

resultsTwenty-two GPs/307 patients participated in the intervention group, 21 GPs/272 patients in the control group. One hundred twenty-five patients (40.7%) experienced the primary outcome in the intervention group, 87 patients (32.0%) in the control group. The adjusted rates of occurrence of the primary outcome did not differ significantly between the study groups (intention-to-treat analysis: adjusted odds ratio 1.46, 95%CI 0.99-2.18, p = 0.06; per-protocol analysis: adjusted OR 1.33, 95%CI 0.87-2.04, p = 0.2). Hospitalisations as single endpoint occurred more frequently in the intervention group according to the unadjusted analysis (OR 1.61, 95%CI 1.03-2.51, p = 0.04) but not in the adjusted analysis (OR 1.39, 95%CI 0.95-2.03, p = 0.09). Falls occurred less frequently in the intervention group (adjusted OR 0.55, 95%CI 0.31-0.98; p = 0.04). No significant differences were found regarding the other outcomes. Definitive discontinuation was obtained for 67 (16.0%) of 419 drugs rated as inappropriate. About 6% of the prescribed drugs were PIMs.

conclusionsNo conclusive effects were found regarding mortality and non-elective hospitalisations as composite respectively single endpoints. Falls were significantly reduced in the intervention group, although definitive discontinuation was achieved for only one out of six inappropriate drugs. These results indicate that (1) even a modest reduction of inappropriate medications may entail positive clinical effects, and that (2) focusing on evidence-based new drug prescriptions and prevention of polypharmacy may be more effective than deprescribing.

trial registrationCurrent Controlled Trials (ID ISRCTN: 38449870), date: 11/09/2013.

Indexed as

PolypharmacyQuality of LifeAgedHumansInappropriate PrescribingItalyMedication ReviewPrimary Health CareRandomized Controlled Trials as TopicGeneral practiceInappropriate prescribingMedication reviewOlder adultsPolypharmacy

Identifiers

PMID34814835
PMCPMC8609829
OpenAlexW3214891986

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.