Effects of a comprehensive medication review intervention on health‐related quality of life and other clinical outcomes in geriatric outpatients with polypharmacy: A pragmatic randomized clinical trial

摘要

Aim To investigate the effects of a comprehensive medication review intervention on health‐related quality of life (HRQoL) and clinical outcomes in geriatric outpatients exposed to polypharmacy. Methods Pragmatic, nonblinded, randomized clinical trial with follow‐up after 4 and 13?months. Participants were geriatric outpatients taking ≥9 medicines. The intervention was an additional consultation with a physician focusing on reviewing medication, informing patients about their medicines and increasing cross‐sectoral communication as supplement to and compared with usual care. The primary outcome was change in HRQoL after 4?months measured with the EuroQoL 5‐dimension 5‐level (EQ‐5D‐5L) questionnaire. Secondary outcomes were HRQoL after 13?months, mortality, admissions, falls and number of medicines after 4 and 13?months. Results Of 785 eligible patients, 408 were included (age: mean 80.6 standard deviation 7.22 years; number of medicines: median 12 interquartile range 10–14; females 71). After 4?months, the adjusted between‐group difference in EQ‐5D‐5L index score was 0.066 in favour of the medication consultation (95 confidence interval 0.01 to 0.12, P?=?.02). After 4?months, two (1) participants had died in the medication‐consultation group and nine (4) in the usual‐care group (log‐rank test, P?=?.045). The medication consultation reduced the number of medicines by 2.0 (15.8) after 4?months and 1.3 (10.7) after 13?months. There were no statistically significant differences in mortality or HRQoL after 13?months, and no differences in falls or admissions. Conclusions An additional consultation with medication review and increased communication as supplement to usual geriatric outpatient care improved HRQoL and reduced mortality after 4?months.