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Optimising pharmacotherapy In the multimorbid elderly in primary care: a cluster randomised controlled trial (the OPTICA trial)

English title Optimising pharmacotherapy In the multimorbid elderly in primary care: a cluster randomised controlled trial (the OPTICA trial)
Applicant Streit Sven
Number 167465
Funding scheme NRP 74 Smarter Health Care
Research institution Klinik und Poliklinik für Allgemeine Innere Medizin Inselspital
Institution of higher education University of Berne - BE
Main discipline Internal Medicine
Start/End 01.05.2017 - 31.12.2021
Approved amount 661'699.00
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All Disciplines (2)

Discipline
Internal Medicine
Information Technology

Keywords (4)

Inappropriate Prescribings; Polypharmacy; Multimorbidity; Potentially Inappropriate Medications

Lay Summary (French)

Lead
Malades chroniques: médication optimisée grâce aux aides électroniques à la decisionLes patients atteints de plusieurs maladies prennent souvent trop de médicaments ou avec des indications inadéquates. L’étude vise à établir si des aides électroniques à la décision destinées aux médecins de famille améliorent l’adéquation de la prescription médicamenteuse et la qualité de vie.
Lay summary

Contexte La majorité des personnes âgées souffre de plusieurs maladies, associées à la prise de nombreux médicaments. Les médecins de famille manquent souvent de temps pour examiner systématiquement la liste de médicaments de leurs patients. Or, des médicaments superflus ou inadéquats ainsi que des erreurs dans la prise des traitements augmentent les risques pour la santé et les coûts de la santé. Les aides électroniques à la décision peuvent soutenir les médecins de famille dans l’examen de la médication et limiter les effets défavorables.

Objectifs Une étude sera réalisée pour tester l’efficacité des aides électroniques à la décision. En outre, une étude qualitative permettra d’analyser l’intégration de l’outil au sein des cabinets des médecins de famille.

Méthodes 40 médecins de famille seront répartis dans un groupe d’intervention et un groupe témoin. Le groupe d’intervention bénéficiera des résultats de l’aide électronique à la décision alors que le groupe témoin suivra ses pratiques habituelles. Les médecins de famille décideront d’entente avec le patient ou la patiente d’accepter ou non les propositions de modifications des traitements. Après une année, l’adéquation de la prescription médicamenteuse, l’utilisation des services de santé (p.ex. hospitalisations, visites aux urgences), la fréquence des chutes, la qualité de vie et les coûts seront comparés entre les deux groupes. En outre, les facteurs favorables et défavorables à l’introduction de cet outil en cabinet seront étudiés.

Importance L’outil d’aide à la décision devrait contribuer à optimiser la prescription médicamenteuse pour les patients atteints de maladies chroniques, améliorer la qualité de vie et diminuer les coûts. En cas d’efficacité avérée, l’outil pourra être utilisé par tous les cabinets médicaux.

Direct link to Lay Summary Last update: 11.01.2017

Responsible applicant and co-applicants

Employees

Project partner

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Medix Generalversammlung Talk given at a conference Feuer fangen für FIRE 07.06.2018 Bern, Switzerland Streit Sven;
Qualitätszirkel Belp Individual talk Informationen zur OPTICA Studie bei Hausärzten 28.05.2018 Belp, Switzerland Streit Sven;
PraxisUpdate Bern Talk given at a conference Multimorbidität und Polypharmazie: eine Herausforderung im Praxisalltag 07.12.2017 Bern, Switzerland Streit Sven;
FIRE User Meeting Talk given at a conference Die OPTICA Studie 25.10.2017 Zurich, Switzerland Jungo Katharina Tabea; Streit Sven;


Communication with the public

Communication Title Media Place Year
Media relations: print media, online media Die OPTICA-Studie Primary and Hospital Health Care Italian-speaking Switzerland Rhaeto-Romanic Switzerland German-speaking Switzerland Western Switzerland 2018

Associated projects

Number Title Start Funding scheme
172676 Neuropsychiatric outcomes, muscular function and exploration of metabolic pathways disrupted in subclinical thyroid dysfunction: a prospective evaluation and impact of treatment 01.07.2017 Project funding (Div. I-III)

Abstract

State of Research: Policy makers are faced with many challenges, as they plan health care systems to meet the needs of the fast growing aging population. More than 60% of the elderly suffer from multiple chronic conditions (multimorbidity) and get multiple drugs (polypharmacy). However, multimorbid patients are often excluded from randomized clinical trials (RCTs) and most guidelines address diseases in isolation. Inappropriate drug prescription and poor compliance contribute to up to 30% of hospital admissions and yield to 20% of unjustified overt healthcare costs. About 3% of deaths are related to inappropriate prescription and adverse drug events. Elderly patients usually rely on general practitioners (GPs) to manage their treatments, but GPs often have limited time to adapt polypharmacy. Reviewing medications and understanding their interactions based on a list of diagnoses and drugs is time consuming; most GPs see patients for just 15 minutes. Pilot data have shown that a software-assisted method was effective for optimising pharmacotherapy in GP practices.Aim: We will assess the effectiveness of a user-friendly, software-assisted method (STRIP: Systematic Tool to Reduce Inappropriate Prescribing) in optimizing the pharmacotherapy of multimorbid elderly patients in GP practices. The primary outcome will be the change in appropriateness of drug therapy. Secondary outcomes will include health care utilisation (drug utilisation and number of care episodes by type, including unplanned hospitalisations, office visits, urgent care and emergency department visits), falls, QoL changes, and costs. We will also conduct a qualitative study of barriers to implementing the software for wider implementation in GP practices.Methods: We will conduct a cluster randomised controlled trial (RCT) that randomises GPs instead of patients, to prevent contamination that would occur if the same GPs treated patients in the intervention and the control arm simultaneously. We will compare the effectiveness of adding a user-friendly software STRIP for optimizing pharmacotherapy among multimorbid elderly patients in GP practices to usual care. STRIP is designed to optimise drug therapy and advise on safe and appropriate therapy using the STOPP/START criteria (screening tool to identify over- and underused drugs), monitors interactions, and suggests appropriate doses based on renal and liver function. For outcomes, appropriateness of drug therapy will be measured with the medication appropriateness index (MAI) and the assessment of underutilization index (AOU) at 12 months. To successfully integrate this new software tool into GP practices, we will collaborate with the “Institut für Praxisinformatik” (IPI, Institute for informatics in medical practice) and FIRE (family medicine icpc research using medical records) that allows an automatic collection of data from GP practices. This project extends the EU-funded OPERAM trial (“Optimising PharmacothERApy in the Multimorbid Elderly”, Coordinator for Europe: Prof N Rodondi) from hospitals to GP practices. We will include 320 patients aged = 65 years with multimorbidity and polypharmacy treated by 40 GPs.Relevance: Optimizing drug therapy in the multimorbid elderly and discontinuing less effective interventions may significantly reduce health care utilisation, improve QoL and decrease health costs in Switzerland. The STRIP tool will personalise healthcare delivery. In contrast to previous RCTs, our strength is to avoid a time-consuming intervention for GPs by using automated software to give advice to GPs on which drugs to stop or start. Our strong partnership with IPI and FIRE, two key players in Swiss eHealth strategies, makes it feasible to test this intervention and its impact directly in daily GP practices in Switzerland, with results that can be immediately disseminated.
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