Team Approach to Polypharmacy Evaluation and Reduction

Summary

In an aging population, most seniors suffer from multiple chronic conditions. When the number of medications taken is ≥5 (polypharmacy), the burden of taking so many together can do more harm than good. This study will test a program focused on medication reduction involving patient, pharmacist and physician using current technology aimed at reducing the harms of polypharmacy. Reducing the risk of adverse effects from drugs or the interactions between them involves prioritizing the most important ones according to the patient's preference and stopping those which may no longer be necessary. Reducing the dose also reduces the risk of drug side effects. Patients, aged over 69 years taking ≥5 medications, will randomly receive the program immediately or at 6 months. The program involves information gathering from the patient, medication review with the pharmacist and then a consultation with the family doctor focused on discontinuing/reducing the dose of medications where possible using a 'pause and monitor' framework to assess the need for restart. An electronic program that detects drug adverse effects and flags potentially inappropriate medications will be integrated into a clinical pathway incorporating monitoring and follow up systems. This study will examine effects on patient and health relevant outcome measures as well as patients' and clinicians' experiences of the program. The results will be used to determine whether this system can be implemented as part of routine preventative care in older adults.

Conditions

• Comorbidity
• Medication Therapy Management

Interventions

OTHER

TAPER program

Patients will be randomized to receive the TAPER program at study start or delayed intervention at 6 months.

Sponsors & Collaborators

• Health Canada

  collaborator OTHER_GOV

• The Labarge Optimal Aging Initiative

  collaborator OTHER

• David Braley and Nancy Gordon Chair in Family Medicine

  collaborator OTHER

• RxISK

  collaborator INDUSTRY

• McMaster University

  lead OTHER

Principal Investigators

• Dee Mangin, MBChB, DPH, FRNZC, MD · McMaster University

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

70 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2015-10-31

Primary Completion

2019-11-30

Completion

2019-11-30

Countries

• Canada

Study Locations