61654 20220525082802.0 doi 10.1186/s13012-017-0584-x sideral 99064 ART-2017-99064 eng Prados-Torres, A. Universidad de Zaragoza (orcid)0000-0002-5704-6056 Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy: Study protocol of a cluster randomized clinical trial (Multi-PAP project) 2017 Access copy available to the general public Unrestricted Background: Multimorbidity is associated with negative effects both on people''s health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (=3 chronic diseases) and polypharmacy (=5 drugs prescribed in =3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799 info:eu-repo/grantAgreement/EUR/ERDF/A way to build Europe 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/REDISSEC/RD12-0001-0012 info:eu-repo/grantAgreement/ES/REDISSEC/RD16-0001-0005 info:eu-repo/semantics/openAccess by http://creativecommons.org/licenses/by/3.0/es/ 4.345 2017 HEALTH POLICY & SERVICES 5 / 79 = 0.063 2017 Q1 T1 HEALTH CARE SCIENCES & SERVICES 10 / 94 = 0.106 2017 Q1 T1 2.443 2017 Health Informatics 2017 Q1 Public Health, Environmental and Occupational Health 2017 Q1 Medicine (miscellaneous) 2017 Q1 Health Policy 2017 Q1 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion del Cura-González, I. Prados-Torres, D. López-Rodríguez, J.A. Leiva-Fernández, F. Calderón-Larrañaga, A. (orcid)0000-0001-9064-9222 López-Verde, F. Gimeno-Feliu, L.A. Universidad de Zaragoza (orcid)0000-0003-2928-6623 Escortell-Mayor, E. Pico-Soler, V. Sanz-Cuesta, T. Bujalance-Zafra, M.J. Morey-Montalvo, M. Boxó-Cifuentes, J.R. Poblador-Plou, B. Fernández-Arquero, J.M. González-Rubio, F. Universidad de Zaragoza (orcid)0000-0003-2580-2002 Ramiro-González, M.D. Coscollar-Santaliestra, C. Universidad de Zaragoza (orcid)0000-0002-4817-9527 Martín-Fernández, J. Barnestein-Fonseca, M.P. Valderas-Martínez, J.M. Marengoni, A. Muth, C. Aza-Pascual-Salcedo, M. Poncel-Falcó, A. Bandrés-Liso, A.C. Alcaraz-Borrajo, M. Ruiz-San-Basilio, J.M. Mataix-San-Juan, A. López-León, A.M. Mateos-Sancho, C. Gimeno-Miguel, A. Hernández-Santiago, V. García de Blas, F. García-Agua, N. Rodríguez-Barrientos, R. Vázquez-Alarcón, R. Laguna-Berna, C. Márquez-Chamizo, M.I. Marta-Moreno, J. Azcoaga-Lorenzo, A. Abad-Díez, J.M. Sánchez-Perruca, L. Polentinos-Castro, E. Clerencia-Sierra, M. Ariza-Cardiel, G. González-González, A.I. Rico-Blázquez, M. Rogero-Blanco, M. Tello-Bernabé, M.E. Álvarez-Villalba, M. Rumayor-Zarzuelo, M. del Pozo, C.S.C. Torrente Garrido, J.I. Universidad de Zaragoza (orcid)0000-0002-9195-5309 Aranda, C.G. Lafuente, M.P. Delgado Marroquín, Ma.Teresa Universidad de Zaragoza (orcid)0000-0002-7607-3199 Molina, M.J.G. Bernal, J.C. Martín, M.V.A. Domínguez, S.G. Gorbea, C.B. Negre, A.L.O. Royo, E.G. Taira, M.B.A. Gutiérrez, J.F.T. Quintana, J.P. Miguel, V.M. de las Heras, E.M. Algora, C.E. de Letosa, M.T.M.N. Gascón del Prim, Elena Delgado, N.S. Sanjuan Cortés, Ma Rosario Sánchez, T.C. Lucas, E.D. Mínguez Sorio, M.P. Marzal, A.C. García, E.D. Álvarez, J.C.G. de Blas González, F.G. Pérez, C.G. Franco, A.L.G. Beneitez, M.E.V. Ballarín González, Ana Zapata, M.I.F. Suarez, E.G. Ortiz, F.M. Laguno, L.C.P. Gómez, J.L.Q. Pascual, E.R. López, F.R.A. Álvaro, C.C. González, P.C. Hamalainen, S.M.M. Fernández, R.M. Blanco, M.E.R. Arce, C.S. Wiesman, E.C. Galindo, J.O. Marcos, C.L. Borda, S.L. Fernández, J.C.M. Gómez, B.M. de Mingo, E.R. Pascual, J.P.C. Barroso, M.G. Serrano, B.L. Peláez, M.P.M. González, F.P. Salvador, J.S. Yépez, J.D.S. Alonso, A.S. Villalba, M.M.Á. Tapia, P.M. Alcántara, M.A.F. Alonso, M.C.H. González, R.I. Antón, M.A.M. Pérez, M.A.A. Lorenzo, A.A. Medina, R.D.F. Laguna, A.N.L. de Rivera, E.M.C. Flores, I.S. Rodríguez, M.J.S. Isabel, M.S.N. Sánchez, J.M.R. Llanos, P.S. Campillo, L.V. Izquierdo, J.M. Sainz, M.T. Jiménez, M.J.F. García, E.M. Navarro Jiménez, J.M. Gómez, D.G. Mendoza, L.G. de la Mota, Ybancos, Luz Pilar Genafo, J.S. Rodríguez, M.J.A. Garach, E.B. Arteaga, B.C.d. Parrilla, M.D.G. Sánchez Morales, Catalina Chasco, M.M.L. Ríos, I.M. Delgado, E.M. Aurioles, E.M. Ruiz, S.H. Escalante, N.M. Salido, E.L. Torres, M.A.M. Rodríguez, M.L.M. Gálvez, E.P. Torres, J.M.R. Fernández, C.T. Cañavate, M.D.G.M. Mellado, M.M.G. Pradilla, M.V.M. Peña, M.J.C. Fernández, J.L. Romero, V.C. Maqueda, R.Á. Valdés, G.A. Santaella, M.D. Vargas, A.M.F. García, I.G. Rod 1007 610 Universidad de Zaragoza Dpto. Medicina, Psiqu. y Derm. Area Medicina 1008 615 Universidad de Zaragoza Dpto. Microb.Med.Pr.,Sal.Públ. Área Medic.Prevent.Salud Públ. 12, 1 (2017), 54 [10 pp] Implementation Science Implementation Science 1748-5908 1421916 http://zaguan.unizar.es/record/61654/files/texto_completo.pdf Versión publicada 78919 http://zaguan.unizar.es/record/61654/files/texto_completo.jpg?subformat=icon icon Versión publicada oai:zaguan.unizar.es:61654 articulos driver 2022-05-25-08:24:08 ARTICLE