A Swiss Interprofessional Network for Reviewing Inappropriate Medication in Primary Care: a Pilot Study
试验速览
- 阶段
- 不适用
- 状态
- Enrolling By Invitation
- 入组人数
- 250
- 试验地点
- 1
- 主要终点
- Number of participants recruited and percentage of participants retained
研究概览
简要总结
The aim of the SINERGIC pilot study is to assess the feasibility in the Swiss context of implementing interprofessional medication reviews between GP and pharmacists, as part of a shared decision-making process with patients. The acceptability and potential effectiveness of such an intervention will also be assessed.
This assessment will enable the investigators to take into account the determining factors for setting up a large-scale study to support the sustainable financing of this service in the long term.
详细描述
The ageing population is leading to an increase in the prevalence of chronic conditions among older adults, often resulting in excessive polypharmacy. Polypharmacy, as well as the prescription of high-risk medications in this population, exposes them to more adverse effects, which can lead to falls and hospitalisation. This problem is of concern to healthcare professionals, whether they be general practitioners (GP), who have an overview of medical records, or dispensing pharmacists, who have an overview of medication. In Switzerland, these two professions still operate often in isolation from each other, but genuine collaboration is essential if we are to improve and manage polypharmacy among the elderly and limit the risks. Medication reviews are recognised as promising strategies for improving the quality of prescribing in patients with multiple medications.
This pilot trial does not randomly select participants and does not include a control group. It is a hybrid study that aims both to test the effectiveness of the intervention and to prepare for its implementation.
The study plans to include at least 250 patients from three groups of general practices in different settings. Participants will be aged 65 or older, take at least five chronic medications, and suffer from at least three chronic conditions. Individuals living in medical institutions will not be included.
Intervention:
- Step 1 (optional): Patients taking at least 10 chronic medications and experiencing adherence or side effect issues may benefit from a specialised consultation with a pharmacist.
- Step 2: The pharmacist identifies any medication-related issues for each patient and discusses them directly with the general practitioner in order to agree on the necessary adjustments.
- Step 3: During a medical appointment, the doctor and patient will decide together whether to implement the proposed changes.
- Step 4: The pharmacist will follow up after a few days and then again after 3 months.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 65 Years 至 —（Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Age ≥ 65 years old;
- •Regular use of at least 5 medications (chronic treatments, > 3 months);
- •Patients with a minimum of 3 chronic diseases;
- •Regular follow-up in a GP practice taking part in the project;
- •Adequate understanding of French.
- •Written informed consent
排除标准
- •Residence in an institution (residential care facility, nursing home, etc.) ;
- •Cognitive impairment preventing understanding or obtaining informed consent;
- •Any other clinical situation deemed incompatible with participation, as decided by the GP in charge.
研究组 & 干预措施
Patient with medication review
干预措施: Medication review (Other)
结局指标
主要结局
Number of participants recruited and percentage of participants retained
时间窗: End of the study, expected to be on average after 4-6 months
To assess the ability to recruit patients and retain patients for the duration of the follow-up and, if necessary, to explore the causes leading to their exit from the study; Measure: percentage
Number of GPs recruited and percentage of GPs retained
时间窗: End of the study, expected to be on average after 18 months
To assess the ability to recruit patients and retain patients for the duration of the follow-up and, if necessary, to explore the causes leading to their exit from the study; Measure: percentage
次要结局
- Score of participants' acceptability of the intervention (Patients Reported Experience Measures)(End of the study, expected to be on average after 4-6 months)
- Score of the healthcare professionals' acceptability of the intervention(End of the study, up to 18 months)
- Qualitative evaluation of healthcare professionals' acceptability(End of the study, up to 18 months)
- Number and percentage of clinically relevant drug related problems resolved(3 months after medical consultation)
- Amount of drug cost savings(3 months after medical consultation)
- Cost of the service(During interprofessional meeting between GP and pharmacist)
- Score on health-related quality of life (Patient-Reported Outcomes Measures or PROMs)(3 months after medical consultation)