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Sponsoring of onderzoeksgeld
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Andere relatie, namelijk …

3. NHG wetenschapsdag / Sanne Verdoorn / 08-06-2018
Effects of a clinical medication review focused on personal goals in older persons with polypharmacy
Hier alle auteurs weergeven.
NHG wetenschapsdag / Sanne Verdoorn /

4. Results of the DREAMeR study
Drug use Reconsidered in the Elderly using goal Attainment scales during Medication Review

5. Background
Clinical medication reviews (CMR) are increasingly performed
CMR can reduce drug-related problems (DRPs)
Little evidence for effects on clinical outcomes
Quality of life
Hospital admissions
Clinical medication reviews (CMR) are increasingly performed by GPs and pharmacists internationally and in the NL.

6. Objective
To investigate the effects of a CMR, focused on personal goals, on quality of life and health-related complaints in older patients with polypharmacy

7. Methods Randomized Controlled Trial (RCT)
35 Dutch Community pharmacies
113 cooperating general practices

8. Methods Inclusion criteria: ≥ 70 years ≥ 7 drugs
n = 629 patients randomized
Intervention (n=315)
Clinical medication review
Follow-up: after 3 and 6 months
Control group waiting list
CMR focused on patient wishes complaints and goals

9. Clinical medication review
√ Questionnaire about complaints
√ Preferences
√ Goals
1. Patient interview by pharmacist
2. Pharmacotherapeutic Analysis
3. Pharmaceutical care plan: GP and pharmacist
4. Discussion with patient
5. Follow-up and monitoring
This is the overview of a CMR, where both patient, GP and pharmacist are involved.
New in this intervention was the focus on the patient interview.
We focused on patient’s related complaints, wishes and goals during the interview and tried to propose one or more health-realted goals at the end of the interview.
These goals were evaluated with goal attainment scaling. .

10. Outcome measures Quality of life EQ-5D  utility scores (0-1)
EQ-VAS (0-100)
Health-related complaints
Number of complaints with impact on patient’s daily life
VAS score ≥5
Influence daily life: moderate, severe, extreme
Number of drugs

11. Health-related complaints
Pain
Itching
Dyspnoea
Mobility problems
Dizziness
Sedation
Constipation/diarrhea
Gastric complaints
Cognition
Fatigue
Dry mouth
Incontinence
In total we have measured 12 health-related complaints, based on the most common complaints in older people and most common side effects of medicines.
And things that we can influence with medication or medical aids.

12. Statistical analysis Lineair mixed model analysis
3 measurements over time
Adjustment for age, sex and pharmacy
We had repeated mesurements, so we could adjust for differences between the individuals.
There were no differences between baseline outcomes between both groups.

13. Results – Quality of life (EQ-VAS)
First we see the group averages of both intervention and control group at baseline and after 6 months.
CG decreased from 70 to 69 and IG increased from 68 to 70.
When we put all the results in the LMM, we can see that the effect after 6 months (the beta) is that the IG 3.4 points more on the VAS scale compared to CG, which was stat. Sign.
LMM: β = 3,4; p < 0,01

14. Results – Quality of life (utility)
Here we see the group averages of the utility scores for both groups. They were pretty high for this population, but there was no difference in utility scores after 6 months for both groups.
LMM: β = -0,0022; p = 0,89

15. Results – Complaints with impact
We see that on baseline CG had an average of 2.6 complaints with impact on daily life and IG 2.8.
The IG decreased more than CG.
When we put this in the LMM analysis we see an effect of 12%. The IG decreased points more compared to CG after 6 months.
LMM: β = -0,34 (12%); p = 0,029

16. Results – number of drugs
Finally, have a look to the number of drugs.
We had monthly data from the number of drugs, beacuse we used drug dispensing data to calculate this.
When we finally look at the number of drugs, we see that in the IG both more drugs are added as ceased compared to CG, but overall there was slight decrease in number of drugs after 6 months in the IG compared to CG.
LMM: β = -0,32; p<0,01

17. Conclusion
A CMR focused on personal goals, improved the health-related quality of life (EQ-VAS) and reduced the number of health-related complaints with impact for the patient, while the number of drugs used decreased

18. Discussion Limitations Strengths Pragmatic trial Innovative
Patient centred approach
Patient reported outcomes
1st study using GAS and complaints in CMR
1st study effect on EQ-VAS and complaints
Limitations
No blinding possible
Complaints questionnaire “new”
Proposing goals can be risky  SMART

19. Thank you for the attention!
Authors:
Sanne Verdoorn MSc
Dr. Henk-Frans Kwint
Dr. Jeanet Blom
Prof. dr. Jacobijn Gussekloo
Prof. dr. Marcel L. Bouvy
Contact:
Dit naar begin.

20. Thank you for the attention!
A CMR focused on personal goals, improved the health-related quality of life (EQ-VAS) and reduced the number of health-related complaints with impact for the patient, while the number of drugs used decreased
Contact:
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