Sanne Verdoorn|Henk?Frans Kwint|Jeanet W. Blom|Jacobijn Gussekloo|Marcel L. Bouvy
Effects of a clinical medication review focused on personal goals, quality of life, and health problems in older persons with polypharmacy: A randomised controlled trial (DREAMeR-study)
Pharmo Institute|Utrecht University|SIR Institute for Pharmacy Practice and Policy|SIR Institute for Pharmacy Practice and Policy|Leiden University|Leiden University|Pharmo Institute|Utrecht University|SIR Institute for Pharmacy Practice and Policy
background clinical medication reviews cmrs increasingly performed older persons multimorbidity polypharmacy reduce drugrelated problems drps however limited evidence cmr improve clinical outcomes little attention paid patients preferences needs aim study investigate effect patientcentred cmr focused personal goals healthrelated quality life hrqol number health problems methods findings study randomised controlled trial rct performed 35 community pharmacies cooperating general practices netherlands communitydwelling older persons 70 years polypharmacy 7 longterm medications randomly assigned usual care receive cmr randomisation performed patient level per pharmacy using block randomisation primary outcomes hrqol assessed euroqol eq5d5l eqvisual analogue scale vas number health problems pain dizziness 3 6 months health problems measured selfdeveloped written questionnaire total number health problems number health problems moderate severe impact daily life april 2016 february 2017 recruited 629 participants 54 females median age 79 years randomly assigned receive intervention n 315 usual care n 314 6 months intervention group hrqol measured eqvas increased 34 points 95 confidence interval ci 094 58 p 0006 number health problems impact daily life decreased 12 difference 6 months 034 95 ci 062 0044 p 0024 compared control group significant difference intervention group control group hrqol measured eq5d5l difference 6 months 00022 95 ci 0024 0020 p 085 total number health problems difference 6 months 030 95 ci 064 0054 p 0099 main study limitations include risk bias due lack blinding difficulties demonstrating part complex intervention example goal setting extra attention patients reducing health problems drug changes contributed effects observed conclusions study observed cmr focused personal goals improved older patients lives wellbeing increasing quality life measured eqvas decreasing number health problems impact daily life although significantly affect quality life measured eq5d including patients personal goals preferences medication review may help establish effects outcomes relevant older patients lives trial registration netherlands trial register ntr5713