151054 20251017144633.0 doi 10.3390/jpm12050752 sideral 129151 ART-2022-129151 eng Cura-González, Isabel del How to Improve Healthcare for Patients with Multimorbidity and Polypharmacy in Primary Care: A Pragmatic Cluster-Randomized Clinical Trial of the MULTIPAP Intervention 2022 Access copy available to the general public Unrestricted (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. info:eu-repo/grantAgreement/ES/ISCIII/FIS/PI15-00276 info:eu-repo/grantAgreement/ES/ISCIII/FIS/PI15-00572 info:eu-repo/grantAgreement/ES/ISCIII/FIS/PI15-00996 info:eu-repo/grantAgreement/ES/ISCIII/RD16-0001-0004 info:eu-repo/grantAgreement/ES/ISCIII/RD16-0001-0005 info:eu-repo/grantAgreement/ES/ISCIII/RD16-0001-0006 info:eu-repo/semantics/openAccess by https://creativecommons.org/licenses/by/4.0/deed.es 3.4 2022 MEDICINE, GENERAL & INTERNAL 67 / 169 = 0.396 2022 Q2 T2 HEALTH CARE SCIENCES & SERVICES 42 / 107 = 0.393 2022 Q2 T2 0.665 2022 Medicine (miscellaneous) 2022 Q2 2.6 2022 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion López-Rodríguez, Juan A. Leiva-Fernández, Francisca Gimeno-Miguel, Antonio (orcid)0000-0002-5440-1710 Poblador-Plou, Beatriz (orcid)0000-0002-5119-5093 López-Verde, Fernando Lozano-Hernández, Cristina Pico-Soler, Victoria Bujalance-Zafra, María Josefa Gimeno-Feliu, Luis A. Universidad de Zaragoza (orcid)0000-0003-2928-6623 Aza-Pascual-salcedo, Mercedes Rogero-Blanco, Marisa González-Rubio, Francisca García-De-blas, Francisca Polentinos-Castro, Elena Sanz-Cuesta, Teresa Castillo Jimena, Marcos Alonso-García, Marcos Calderón-Larrañaga, Amaia Valderas, José M. Marengoni, Alessandra Muth, Christiane Prados-Torres, Juan Daniel Prados-Torres, Alexandra 1007 610 Universidad de Zaragoza Dpto. Medicina, Psiqu. y Derm. Area Medicina 12, 5 (2022), [16 pp.] J. pers. med. Journal of Personalized Medicine 2075-4426 719394 http://zaguan.unizar.es/record/151054/files/texto_completo.pdf Versión publicada 2989808 http://zaguan.unizar.es/record/151054/files/texto_completo.jpg?subformat=icon icon Versión publicada oai:zaguan.unizar.es:151054 articulos driver 2025-10-17-14:27:34 ARTICLE