MultiPAP Plus: Improving Prescription in Primary Care Patients With Multimorbidity and Polypharmacy

NCT ID: NCT04147130

Last Updated: 2023-12-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

1162 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-02-18

Study Completion Date

2023-12-26

Brief Summary

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This study assesses the effectiveness of a complex intervention in young-old patients with multimorbidity and polypharmacy aimed at improving physician drug prescription in primary care, measured by hospitalization-mortality at six 6 (T1), 12 (T2) and 18 (T3) months from baseline compared to usual care.

Detailed Description

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Design: Pragmatic cluster randomized clinical trial with 18 months follow-up.

Unit of randomization: general practitioner.

Unit of analysis: patient.

Setting: Primary Health Care Centres in three different Spanish Autonomous Communities (Aragón, Madrid and Andalucía).

Population: Patients 65-74 years of age with multimorbidity (3 or more chronic diseases) and polypharmacy (5 or more drugs taken for at least three months). N=1234 patients (617 in each arm, 8 patients per physician) will be recruited by general practitioners before randomization.

Intervention: Complex intervention incorporating previous MultiPAP intervention (based on the ARIADNE principles with two main components: 1) Training of general practitioners and 2) Patient-centered clinical interview) And it adds a clinical-decision support system to help structured treatment-plan review.

Control group: usual care.

Variables: First level (Patient): a) Main: hospitalizations and/or mortality; b) Secondary: health services use, quality of life (Euroqol 5D-5L), disability (WHODAS), fractures, pharmacotherapy and adherence to treatment (Morisky-Green), clinical and socio-demographic. Second level (Physician): a) Socio-demographic. b) CDSS use: acceptance and satisfaction of health care provider use c) Professional background: time in the position, center characteristics and medical education involvement.

Analysis: All analyses will be carried out adhering to the intention-to-treat principle. Description of baseline characteristics. Basal comparison between groups. Analysis of primary outcome: difference in percentages in the final combined variable from 0 (T0) to 18 months (T3), with its corresponding 95% CI. Adjustement by main confounding and prognostic factors will be performed through a multilevel analysis.

Conditions

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Multimorbidity Polypharmacy Comorbidities and Coexisting Conditions Clinical Decision-Support Systems

Keywords

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Primary Health Care Medication Adherence Disability Patient-Centered Care Ariadne Principles

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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MultiPAP Plus intervention

Complex intervention with general practitioners and patients

Group Type EXPERIMENTAL

MultiPAP Plus

Intervention Type OTHER

Complex intervention incorporating previous MultiPAP intervention (based on the ARIADNE principles with two main components: 1) Training of general practitioners and 2) Patient-centered clinical interview) And it adds a clinical-decision support system to help structured treatment-plan review.

Usual care

Intervention Type OTHER

Patients will receive the usual clinical care based on current clinical practice guidelines.

Usual care

Patients will recieve the usual clinical care

Group Type ACTIVE_COMPARATOR

Usual care

Intervention Type OTHER

Patients will receive the usual clinical care based on current clinical practice guidelines.

Interventions

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MultiPAP Plus

Complex intervention incorporating previous MultiPAP intervention (based on the ARIADNE principles with two main components: 1) Training of general practitioners and 2) Patient-centered clinical interview) And it adds a clinical-decision support system to help structured treatment-plan review.

Intervention Type OTHER

Usual care

Patients will receive the usual clinical care based on current clinical practice guidelines.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Patients 65-74 years of age with multimorbidity (3 or more chronic diseases) and polypharmacy (5 or more drugs taken for at least three months).
* Informed consent.

Exclusion Criteria

* Institutionalized patient at nursing homes or similar
* Life expectancy \< 12 months
Minimum Eligible Age

65 Years

Maximum Eligible Age

74 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Gerencia de Atención Primaria, Madrid

OTHER_GOV

Sponsor Role collaborator

Aragon Institute for Health Research (IIS Aragón)

UNKNOWN

Sponsor Role collaborator

Andaluz Health Service

OTHER_GOV

Sponsor Role collaborator

Fundación de Investigación e Innovación Biomédica Atención Primaria (FIIBAP)

UNKNOWN

Sponsor Role collaborator

Red de Investigación en Servicios de Salud en Enfermedades Crónicas

OTHER

Sponsor Role collaborator

Instituto de Salud Carlos III

OTHER_GOV

Sponsor Role collaborator

Instituto Aragones de Ciencias de la Salud

OTHER_GOV

Sponsor Role lead

Responsible Party

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Alexandra Prados Torres

Principal Investigator, MD, PhD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Alexandra Prados-Torres, MD,PhD

Role: PRINCIPAL_INVESTIGATOR

Instituto Aragonés de Ciencias de la Salud (IACS)

Daniel Prados-Torres, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Servicio Andaluz de Salud (Andaluz Health Service)

Isabel Del Cura-González, MD,PhD

Role: PRINCIPAL_INVESTIGATOR

Gerencia Asistencial de Atención Primaria, Madrid

Locations

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Servicio Andaluz de Salud

Málaga, Andalusia, Spain

Site Status

Instituto Aragonés de Ciencias de la Salud (IACS)

Zaragoza, Aragon, Spain

Site Status

Gerencia Asistencial de Atención Primaria de Madrid

Madrid, , Spain

Site Status

Countries

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Spain

References

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Del Cura-Gonzalez I, Lopez-Rodriguez JA, Leiva-Fernandez F, Gimeno-Feliu LA, Pico-Soler V, Bujalance-Zafra MJ, Dominguez-Santaella M, Polentinos-Castro E, Poblador-Plou B, Ara-Bardaji P, Aza-Pascual-Salcedo M, Rogero-Blanco M, Castillo-Jimenez M, Lozano-Hernandez C, Gimeno-Miguel A, Gonzalez-Rubio F, Medina-Garcia R, Gonzalez-Hevilla A, Gil-Conesa M, Martin-Fernandez J, Valderas JM, Marengoni A, Muth C, Prados-Torres JD, Prados-Torres A; MULTIPAP PLUS Group. Effectiveness of the MULTIPAP Plus intervention in youngest-old patients with multimorbidity and polypharmacy aimed at improving prescribing practices in primary care: study protocol of a cluster randomized trial. Trials. 2022 Jun 9;23(1):479. doi: 10.1186/s13063-022-06293-x.

Reference Type DERIVED
PMID: 35681224 (View on PubMed)

Other Identifiers

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PI 18/01303,18/01515,18/01812

Identifier Type: -

Identifier Source: org_study_id