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Original Investigation
October 16, 2019

Effect of Clinical Geriatric Assessments and Collaborative Medication Reviews by Geriatrician and Family Physician for Improving Health-Related Quality of Life in Home-Dwelling Older Patients Receiving Polypharmacy: A Cluster Randomized Clinical Trial

Author Affiliations
  • 1Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  • 2Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
  • 3Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
  • 4Institute of Health and Society, University of Oslo, Oslo, Norway
  • 5School of Pharmacy, University of Oslo, Oslo, Norway
  • 6Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
  • 7Department of Research and Development, Telemark Hospital Trust, Skien, Norway
  • 8Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
  • 9Department of General Practice, University of Helsinki, Helsinki, Finland
  • 10Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
  • 11Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Oslo, Norway
  • 12Health Service Research Unit, Department of Neurology, Akershus University Hospital, Lørenskog, Norway
  • 13Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
JAMA Intern Med. Published online October 16, 2019. doi:https://doi.org/10.1001/jamainternmed.2019.5096
Key Points

Question  Can clinical geriatric assessments and collaborative medication reviews carried out by a geriatrician in cooperation with the patient’s family physician have positive effects on health-related quality of life in older patients receiving polypharmacy?

Findings  In this cluster randomized clinical trial that included 70 participating family physicians with 174 patients, health-related quality of life after 16 weeks was statistically significantly better in patients who received the intervention compared with those who received usual care.

Meaning  Clinical geriatric assessments and collaborative medication reviews have the potential to improve health-related quality of life among older patients exposed to polypharmacy.

Abstract

Importance  Polypharmacy and inappropriate drug regimens are major health concerns among older adults. Various interventions focused on medication optimization strategies have been carried out, but the effect on patient-relevant outcomes remains uncertain.

Objective  To investigate the effect of clinical geriatric assessments and collaborative medication reviews by geriatrician and family physician (FP) on health-related quality of life and other patient-relevant outcomes in home-dwelling older patients receiving polypharmacy.

Design, Setting, and Participants  Cluster randomized, single-blind, clinical trial. Norwegian FPs were recruited from March 17, 2015, to March 16, 2017, to participate in the trial with their eligible patients. Participants were home-dwelling patients 70 years or older, using at least 7 medications regularly, and having their medications administered by the home nursing service. Patients in the control group received usual care. Randomization occurred at the FP level. A modified intent-to-treat analysis was used.

Intervention  The intervention consisted of 3 main parts: (1) clinical geriatric assessment of the patients combined with a thorough review of their medications; (2) a meeting between the geriatrician and the FP; and (3) clinical follow-up.

Main Outcomes and Measures  The primary outcome was health-related quality of life as assessed by the 15D instrument (score range, 0-1; higher scores indicate better quality of life, with a minimum clinically important change of ±0.015) at week 16. Secondary outcomes included changes in medication appropriateness, physical and cognitive functioning, use of health services, and mortality.

Results  Among 174 patients (mean [SD] age, 83.3 [7.3] years; 67.8% women; 87 randomized to the intervention group and 87 randomized to the control [usual care] group) in 70 FP clusters (36 intervention and 34 control), 158 (90.8%) completed the trial. The mean (SD) 15D instrument score at baseline was 0.708 (0.121) in the intervention group and 0.714 (0.113) in the control group. At week 16, the mean (SD) 15D instrument score was 0.698 (0.164) in the intervention group and 0.655 (0.184) in the control group, with an estimated between-group difference of 0.045 (95% CI, 0.004-0.086; P = .03). Several secondary outcomes were also in favor of the intervention. There were more drug withdrawals, reduced dosages, and new drug regimens started in the intervention group.

Conclusions and Relevance  This study’s findings indicate that, among older patients exposed to polypharmacy, clinical geriatric assessments and collaborative medication reviews carried out by a geriatrician in cooperation with the patient’s FP can result in positive effects on health-related quality of life.

Trial Registration  ClinicalTrials.gov identifier: NCT02379455

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