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  • Pilot study to test the feasibility of a trial design and complex intervention on PRIoritising MUltimedication in Multimorbidity in general practices (PRIMUMpilot)

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General practice / Family practice
Research
Pilot study to test the feasibility of a trial design and complex intervention on PRIoritising MUltimedication in Multimorbidity in general practices (PRIMUMpilot)
  1. Christiane Muth1,
  2. Sebastian Harder2,
  3. Lorenz Uhlmann3,
  4. Justine Rochon3,
  5. Birgit Fullerton1,
  6. Corina Güthlin1,
  7. Antje Erler1,
  8. Martin Beyer1,
  9. Marjan van den Akker1,4,5,
  10. Rafael Perera6,
  11. André Knottnerus4,
  12. Jose M Valderas7,
  13. Ferdinand M Gerlach1,
  14. Walter E Haefeli8
  1. 1Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
  2. 2Institute for Clinical Pharmacology, Johann Wolfgang Goethe University Hospital, Frankfurt/Main, Germany
  3. 3Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
  4. 4Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
  5. 5Department of General Practice, KU Leuven, Leuven, Belgium
  6. 6Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  7. 7Health Services & Policy Research Group, School of Medicine, University of Exeter, Exeter, UK
  8. 8Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
  1. Correspondence to Dr Christiane Muth; muth{at}allgemeinmedizin.uni-frankfurt.de

Abstract

Objective To improve medication appropriateness and adherence in elderly patients with multimorbidity, we developed a complex intervention involving general practitioners (GPs) and their healthcare assistants (HCA). In accordance with the Medical Research Council guidance on developing and evaluating complex interventions, we prepared for the main study by testing the feasibility of the intervention and study design in a cluster randomised pilot study.

Setting 20 general practices in Hesse, Germany.

Participants 100 cognitively intact patients ≥65 years with ≥3 chronic conditions, ≥5 chronic prescriptions and capable of participating in telephone interviews; 94 patients completed the study.

Intervention The HCA conducted a checklist-based interview with patients on medication-related problems and reconciled their medications. Assisted by a computerised decision-support system (CDSS), the GPs discussed medication intake with patients and adjusted their medication regimens. The control group continued with usual care.

Outcome measures Feasibility of the intervention and required time were assessed for GPs, HCAs and patients using mixed methods (questionnaires, interviews and case vignettes after completion of the study). The feasibility of the study was assessed concerning success of achieving recruitment targets, balancing cluster sizes and minimising drop-out rates. Exploratory outcomes included the medication appropriateness index (MAI), quality of life, functional status and adherence-related measures. MAI was evaluated blinded to group assignment, and intra-rater/inter-rater reliability was assessed for a subsample of prescriptions.

Results 10 practices were randomised and analysed per group. GPs/HCAs were satisfied with the interventions despite the time required (35/45 min/patient). In case vignettes, GPs/HCAs needed help using the CDSS. The study made no patients feel uneasy. Intra-rater/inter-rater reliability for MAI was excellent. Inclusion criteria were challenging and potentially inadequate, and should therefore be adjusted. Outcome measures on pain, functionality and self-reported adherence were unfeasible due to frequent missing values, an incorrect manual or potentially invalid results.

Conclusions Intervention and trial design were feasible. The pilot study revealed important limitations that influenced the design and conduct of the main study, thus highlighting the value of piloting complex interventions.

Trial registration number ISRCTN99691973; Results.

  • Multimorbidity
  • comorbidity
  • polypharmacy
  • complex intervention
  • drug therapy, computer-assisted
  • medication adherence

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-011613

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