000151054 001__ 151054 000151054 005__ 20250221105703.0 000151054 0247_ $$2doi$$a10.3390/jpm12050752 000151054 0248_ $$2sideral$$a129151 000151054 037__ $$aART-2022-129151 000151054 041__ $$aeng 000151054 100__ $$aCura-González, Isabel del 000151054 245__ $$aHow to Improve Healthcare for Patients with Multimorbidity and Polypharmacy in Primary Care: A Pragmatic Cluster-Randomized Clinical Trial of the MULTIPAP Intervention 000151054 260__ $$c2022 000151054 5060_ $$aAccess copy available to the general public$$fUnrestricted 000151054 5203_ $$a(1) Purpose: To investigate a complex MULTIPAP intervention that implements the Ariadne principles in a primary care population of young-elderly patients with multimorbidity and polypharmacy and to evaluate its effectiveness for improving the appropriateness of prescriptions. (2) Methods: A pragmatic cluster-randomized clinical trial was conducted involving 38 family practices in Spain. Patients aged 65–74 years with multimorbidity and polypharmacy were recruited. Family physicians (FPs) were randomly allocated to continue usual care or to provide the MULTIPAP intervention based on the Ariadne principles with two components: FP training (eMULTIPAP) and FP patient interviews. The primary outcome was the appropriateness of prescribing, measured as the between-group difference in the mean Medication Appropriateness Index (MAI) score change from the baseline to the 6-month follow-up. The secondary outcomes were quality of life (EQ-5D-5 L), patient perceptions of shared decision making (collaboRATE), use of health services, treatment adherence, and incidence of drug adverse events (all at 1 year), using multi-level regression models, with FP as a random effect. (3) Results: We recruited 117 FPs and 593 of their patients. In the intention-to-treat analysis, the between-group difference for the mean MAI score change after a 6-month follow-up was -2.42 (95% CI from -4.27 to -0.59) and, between baseline and a 12-month follow-up was -3.40 (95% CI from -5.45 to -1.34). There were no significant differences in any other secondary outcomes. (4) Conclusions: The MULTIPAP intervention improved medication appropriateness sustainably over the follow-up time. The small magnitude of the effect, however, advises caution in the interpretation of the results given the paucity of evidence for the clinical benefit of the observed change in the MAI. Trial registration: Clinicaltrials.gov NCT02866799. © 2022 by the authors. Licensee MDPI, Basel, Switzerland. 000151054 536__ $$9info:eu-repo/grantAgreement/ES/ISCIII/FIS/PI15-00276$$9info:eu-repo/grantAgreement/ES/ISCIII/FIS/PI15-00572$$9info:eu-repo/grantAgreement/ES/ISCIII/FIS/PI15-00996$$9info:eu-repo/grantAgreement/ES/ISCIII/RD16-0001-0004$$9info:eu-repo/grantAgreement/ES/ISCIII/RD16-0001-0005$$9info:eu-repo/grantAgreement/ES/ISCIII/RD16-0001-0006 000151054 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttp://creativecommons.org/licenses/by/3.0/es/ 000151054 590__ $$a3.4$$b2022 000151054 591__ $$aMEDICINE, GENERAL & INTERNAL$$b67 / 169 = 0.396$$c2022$$dQ2$$eT2 000151054 591__ $$aHEALTH CARE SCIENCES & SERVICES$$b42 / 107 = 0.393$$c2022$$dQ2$$eT2 000151054 592__ $$a0.665$$b2022 000151054 593__ $$aMedicine (miscellaneous)$$c2022$$dQ2 000151054 594__ $$a2.6$$b2022 000151054 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion 000151054 700__ $$aLópez-Rodríguez, Juan A. 000151054 700__ $$aLeiva-Fernández, Francisca 000151054 700__ $$0(orcid)0000-0002-5440-1710$$aGimeno-Miguel, Antonio 000151054 700__ $$0(orcid)0000-0002-5119-5093$$aPoblador-Plou, Beatriz 000151054 700__ $$aLópez-Verde, Fernando 000151054 700__ $$aLozano-Hernández, Cristina 000151054 700__ $$aPico-Soler, Victoria 000151054 700__ $$aBujalance-Zafra, María Josefa 000151054 700__ $$0(orcid)0000-0003-2928-6623$$aGimeno-Feliu, Luis A.$$uUniversidad de Zaragoza 000151054 700__ $$aAza-Pascual-salcedo, Mercedes 000151054 700__ $$aRogero-Blanco, Marisa 000151054 700__ $$aGonzález-Rubio, Francisca 000151054 700__ $$aGarcía-De-blas, Francisca 000151054 700__ $$aPolentinos-Castro, Elena 000151054 700__ $$aSanz-Cuesta, Teresa 000151054 700__ $$aCastillo Jimena, Marcos 000151054 700__ $$aAlonso-García, Marcos 000151054 700__ $$aCalderón-Larrañaga, Amaia 000151054 700__ $$aValderas, José M. 000151054 700__ $$aMarengoni, Alessandra 000151054 700__ $$aMuth, Christiane 000151054 700__ $$aPrados-Torres, Juan Daniel 000151054 700__ $$aPrados-Torres, Alexandra 000151054 7102_ $$11007$$2610$$aUniversidad de Zaragoza$$bDpto. Medicina, Psiqu. y Derm.$$cArea Medicina 000151054 773__ $$g12, 5 (2022), [16 pp.]$$pJ. pers. med.$$tJournal of Personalized Medicine$$x2075-4426 000151054 8564_ $$s719394$$uhttps://zaguan.unizar.es/record/151054/files/texto_completo.pdf$$yVersión publicada 000151054 8564_ $$s2989808$$uhttps://zaguan.unizar.es/record/151054/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada 000151054 909CO $$ooai:zaguan.unizar.es:151054$$particulos$$pdriver 000151054 951__ $$a2025-02-21-09:53:24 000151054 980__ $$aARTICLE