eprintid: 25166
rev_number: 11
eprint_status: archive
userid: 1589
dir: disk0/00/02/51/66
datestamp: 2018-07-30 11:51:07
lastmod: 2024-04-17 14:05:40
status_changed: 2018-07-30 11:51:07
type: article
metadata_visibility: show
creators_name: Buedingen, Fiona von
creators_name: Hammer, Marc S.
creators_name: Meid, Andreas D.
creators_name: Müller, Walter E.
creators_name: Gerlach, Ferdinand M.
creators_name: Muth, Christiane
title: Changes in prescribed medicines in older patients with multimorbidity and polypharmacy in general practice
subjects: ddc-610
divisions: i-65400
abstract: Background: Treatment complexity rises in line with the number of drugs, single doses, and administration methods, thereby threatening patient adherence. Patients with multimorbidity often need flexible, individualised treatment regimens, but alterations during the course of treatment may further increase complexity. The objective of our study was to explore medication changes in older patients with multimorbidity and polypharmacy in general practice.

Methods: We retrospectively analysed data from the cluster-randomised PRIMUM trial (PRIoritisation of MUltimedication in Multimorbidity) conducted in 72 general practices. We developed an algorithm for active pharmaceutical ingredients (API), strength, dosage, and administration method to assess changes in physician-reported medication data during two intervals (baseline to six-months: ∆1; six- to nine-months: ∆2), analysed them descriptively at prescription and patient levels, and checked for intervention effects.

Results: Of 502 patients (median age 72 years, 52% female), 464 completed the study. Changes occurred in 98.6% of patients (changes were 19% more likely in the intervention group): API changes during ∆1 and ∆2 occurred in 414 (82.5%) and 338 (67.3%) of patients, dosage alterations in 372 (74.1%) and 296 (59.2%), and changes in API strength in 158 (31.5%) and 138 (27.5%) respectively. Administration method changed in 79 (16%) of patients in both ∆1 and ∆2. Simvastatin, metformin and aspirin were most frequently subject to alterations. 

Conclusion: Medication regimens in older patients with multimorbidity and polypharmacy changed frequently. These are mostly due to discontinuations and dosage alterations, followed by additions and restarts. These findings cast doubt on the effectiveness of cross-sectional assessments of medication and support longitudinal assessments where possible.

Trial registration.: 1. Prospective registration: Trial registration number: NCT01171339  ; Name of registry: ClinicalTrials.gov; Date of registration: July 27, 2010; Date of enrolment of the first participant to the trial: August 12, 2010. 2. Peer reviewed trial registration: Trial registration number: ISRCTN99526053  ; Name of registry: Controlled Trials; Date of registration: August 31, 2010; Date of enrolment of the first participant to the trial: August 12, 2010.
date: 2018
publisher: BioMed Central ; Springer
id_scheme: DOI
ppn_swb: 1655671286
own_urn: urn:nbn:de:bsz:16-heidok-251665
language: eng
bibsort: BUEDINGENFCHANGESINP2018
full_text_status: public
publication: BMC Family Practice
volume: 19
number: 131
place_of_pub: London ; Berlin; Heidelberg
pagerange: 1-11
issn: 1471-2296
citation:   Buedingen, Fiona von ; Hammer, Marc S. ; Meid, Andreas D. ; Müller, Walter E. ; Gerlach, Ferdinand M. ; Muth, Christiane  (2018) Changes in prescribed medicines in older patients with multimorbidity and polypharmacy in general practice.  BMC Family Practice, 19 (131).  pp. 1-11.  ISSN 1471-2296     
document_url: https://archiv.ub.uni-heidelberg.de/volltextserver/25166/1/12875_2018_Article_825.pdf