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Title: How to Improve Healthcare for Patients with Multimorbidity and Polypharmacy in Primary Care: A Pragmatic Cluster-Randomized Clinical Trial of the MULTIPAP Intervention
Authors: Del Cura-Gonzalez, Isabel
Lopez-Rodriguez, Juan A
Leiva-Fernandez, Francisca
Gimeno-Miguel, Antonio
Poblador-Plou, Beatriz
Lopez-Verde, Fernando
Lozano-Hernandez, Cristina
Pico-Soler, Victoria
Bujalance-Zafra, Ma Josefa
Gimeno-Feliu, Luis A
Aza-Pascual-Salcedo, Mercedes
Rogero-Blanco, Marisa
Gonzalez-Rubio, Francisca
Garcia-de-Blas, Francisca
Polentinos-Castro, Elena
Sanz-Cuesta, Teresa
Castillo-Jimena, Marcos
Alonso-Garcia, Marcos
Calderon-Larranaga, Amaia
Valderas, Jose M 
Marengoni, Alessandra
Muth, Christiane
Prados-Torres, Juan Daniel
Prados-Torres, Alexandra
Keywords: Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
Medicine, General & Internal
General & Internal Medicine
Ariadne principles
Issue Date: 1-May-2022
Publisher: MDPI
Citation: Del Cura-Gonzalez, Isabel, Lopez-Rodriguez, Juan A, Leiva-Fernandez, Francisca, Gimeno-Miguel, Antonio, Poblador-Plou, Beatriz, Lopez-Verde, Fernando, Lozano-Hernandez, Cristina, Pico-Soler, Victoria, Bujalance-Zafra, Ma Josefa, Gimeno-Feliu, Luis A, Aza-Pascual-Salcedo, Mercedes, Rogero-Blanco, Marisa, Gonzalez-Rubio, Francisca, Garcia-de-Blas, Francisca, Polentinos-Castro, Elena, Sanz-Cuesta, Teresa, Castillo-Jimena, Marcos, Alonso-Garcia, Marcos, Calderon-Larranaga, Amaia, Valderas, Jose M, Marengoni, Alessandra, Muth, Christiane, Prados-Torres, Juan Daniel, Prados-Torres, Alexandra (2022-05-01). How to Improve Healthcare for Patients with Multimorbidity and Polypharmacy in Primary Care: A Pragmatic Cluster-Randomized Clinical Trial of the MULTIPAP Intervention. JOURNAL OF PERSONALIZED MEDICINE 12 (5). ScholarBank@NUS Repository.
Abstract: (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: NCT02866799.
ISSN: 2075-4426
DOI: 10.3390/jpm12050752
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