Shared Decision-Making in Chronic Patients with Polypharmacy: An Interventional Study for Assessing Medication...

Area of Science:

• Geriatrics
• Pharmacology
• Primary Care Medicine

Background:

• Potentially inappropriate medications (PIMs) are linked to polypharmacy and multiple chronic conditions.
• Pharmacotherapy reviews aim to reduce PIM prescribing.
• Effective tools are needed to assess medication appropriateness in complex patient populations.

Purpose of the Study:

• To evaluate the effectiveness of a decision support tool in determining medication appropriateness.
• To assess the tool's impact on patients with chronic diseases (hypertension, dyslipidemia, diabetes) and polypharmacy in primary care.
• To compare a decision support tool intervention with usual clinical practice.

Main Methods:

• A quasi-experimental, randomized, controlled, multicenter study design.
• Intervention group used a paper-based decision support tool, informed about PIMs, risks, and alternatives, promoting shared decision-making.
• Control group received usual clinical practice.

Main Results:

• Medication appropriateness was significantly higher in the intervention group (32.5%) versus the control group (27.9%) after six months (p=0.008).
• The probability of medication appropriateness (drugs withdrawn/replaced per STOPP/Beers criteria, or initiated per START criteria) was 2.8 times higher in the intervention group (OR=2.8; 95% CI 1.3-6.1; p=0.008).
• In patients with good adherence, appropriateness was 62.1% in the shared decision-making group versus 37.9% in the control group (p=0.005).

Conclusions:

• Decision support tools enhance medication appropriateness in patients with PIMs.
• Shared decision-making, facilitated by these tools, improves medication management in primary care.
• The intervention effectively addresses polypharmacy and reduces risks associated with inappropriate medications.