RT Journal Article
T1 Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy: study protocol of a cluster randomized clinical trial (Multi-PAP project).
A1 Prados-Torres, Alexandra
A1 Del Cura-González, Isabel
A1 Prados-Torres, Daniel
A1 López-Rodríguez, Juan A
A1 Leiva-Fernández, Francisca
A1 Calderón-Larrañaga, Amaia
A1 López-Verde, Fernando
A1 Gimeno-Feliu, Luis A
A1 Escortell-Mayor, Esperanza
A1 Pico-Soler, Victoria
A1 Sanz-Cuesta, Teresa
A1 Bujalance-Zafra, Mª Josefa
A1 Morey-Montalvo, Mariel
A1 Boxó-Cifuentes, José Ramón
A1 Poblador-Plou, Beatriz
A1 Fernández-Arquero, José Manuel
A1 González-Rubio, Francisca
A1 Ramiro-González, María D
A1 Coscollar-Santaliestra, Carlos
A1 Martín-Fernández, Jesús
A1 Barnestein-Fonseca, Mª Pilar
A1 Valderas-Martínez, José María
A1 Marengoni, Alessandra
A1 Muth, Christiane
A1 Multi-PAP Group, 
AB Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12 months, as compared with usual care. Design: pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). patients aged 65-74 years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3 months). n = 400 (200 per study arm). complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Clinicaltrials.gov, NCT02866799.
YR 2017
FD 2017-04-27
LK http://hdl.handle.net/10668/11142
UL http://hdl.handle.net/10668/11142
LA en
DS RISalud
RD Mar 17, 2025