RT Journal Article
T1 How to Improve Healthcare for Patients with Multimorbidity and Polypharmacy in Primary Care: A Pragmatic Cluster-Randomized Clinical Trial of the MULTIPAP Intervention.
A1 Del Cura-González, Isabel
A1 López-Rodríguez, Juan A
A1 Leiva-Fernández, Francisca
A1 Gimeno-Miguel, Antonio
A1 Poblador-Plou, Beatriz
A1 López-Verde, Fernando
A1 Lozano-Hernández, Cristina
A1 Pico-Soler, Victoria
A1 Bujalance-Zafra, Mª Josefa
A1 Gimeno-Feliu, Luis A
A1 Aza-Pascual-Salcedo, Mercedes
A1 Rogero-Blanco, Marisa
A1 González-Rubio, Francisca
A1 García-de-Blas, Francisca
A1 Polentinos-Castro, Elena
A1 Sanz-Cuesta, Teresa
A1 Castillo-Jimena, Marcos
A1 Alonso-García, Marcos
A1 Calderón-Larrañaga, Amaia
A1 Valderas, José M
A1 Marengoni, Alessandra
A1 Muth, Christiane
A1 Prados-Torres, Juan Daniel
A1 Prados-Torres, Alexandra
A1 Multi-Pap Group, 
K1 Ariadne principles
K1 multimorbidity
K1 polypharmacy
AB (1) Purpose: To investigate a complex MULTIPAP intervention that implements the Ariadne principles in a primary care population of young-elderly patients with multimorbidity and polypharmacy and to evaluate its effectiveness for improving the appropriateness of prescriptions. (2) Methods: A pragmatic cluster-randomized clinical trial was conducted involving 38 family practices in Spain. Patients aged 65-74 years with multimorbidity and polypharmacy were recruited. Family physicians (FPs) were randomly allocated to continue usual care or to provide the MULTIPAP intervention based on the Ariadne principles with two components: FP training (eMULTIPAP) and FP patient interviews. The primary outcome was the appropriateness of prescribing, measured as the between-group difference in the mean Medication Appropriateness Index (MAI) score change from the baseline to the 6-month follow-up. The secondary outcomes were quality of life (EQ-5D-5 L), patient perceptions of shared decision making (collaboRATE), use of health services, treatment adherence, and incidence of drug adverse events (all at 1 year), using multi-level regression models, with FP as a random effect. (3) Results: We recruited 117 FPs and 593 of their patients. In the intention-to-treat analysis, the between-group difference for the mean MAI score change after a 6-month follow-up was -2.42 (95% CI from -4.27 to -0.59) and, between baseline and a 12-month follow-up was -3.40 (95% CI from -5.45 to -1.34). There were no significant differences in any other secondary outcomes. (4) Conclusions: The MULTIPAP intervention improved medication appropriateness sustainably over the follow-up time. The small magnitude of the effect, however, advises caution in the interpretation of the results given the paucity of evidence for the clinical benefit of the observed change in the MAI. Trial registration: Clinicaltrials.gov NCT02866799.
SN 2075-4426
YR 2022
FD 2022-05-06
LK http://hdl.handle.net/10668/21380
UL http://hdl.handle.net/10668/21380
LA en
DS RISalud
RD Apr 12, 2025