Universität zu Köln

Dinh, Truc Sophia ORCID: 0000-0002-9774-6751, Brueckle, Maria-Sophie, Gonzalez-Gonzalez, Ana Isabel ORCID: 0000-0001-7167-4211, Fessler, Joachim, Marschall, Ursula, Schubert-Zsilavesz, Manfred, Gerlach, Ferdinand M., Harder, Sebastian, van den Akker, Marjan ORCID: 0000-0002-1022-8637, Schubert, Ingrid ORCID: 0000-0002-2191-1773 and Muth, Christiane ORCID: 0000-0001-8987-182X (2022). Evidence-Based Decision Support for a Structured Care Program on Polypharmacy in Multimorbidity: A Guideline Upgrade Based on a Realist Synthesis. J. Pers. Med., 12 (1). BASEL: MDPI. ISSN 2075-4426

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Abstract

Evidence-based clinical guidelines generally consider single conditions, and rarely multimorbidity. We developed an evidence-based guideline for a structured care program to manage polypharmacy in multimorbidity by using a realist synthesis to update the German polypharmacy guideline including the following five methods: formal prioritization in focus groups; systematic guideline review of evidence-based multimorbidity/polypharmacy guidelines; evidence search/synthesis and recommendation development; multidisciplinary consent of recommendations; feasibility test of updated guideline. We identified the need for a better description of the target group, decision support, prioritization of medication, consideration of patient preferences and anticholinergic properties, and of healthcare interfaces. We conducted a systematic guideline review of eight guidelines and extracted and synthesized recommendations using the Ariadne principles. We also included 48 systematic reviews. We formulated and agreed upon 34 recommendations for the revised guideline. During the feasibility test, guideline use enabled 57% of GPs to identify problems, leading to medication changes in 49% and self-assessed improvement in 56% of patients. Although 58% of GPs felt that it was too long, 92% recommended it. Polypharmacy should be systematically reviewed at least annually. Patients, family members, and healthcare professionals should monitor and adjust it using prospective process validation, taking into account patient preferences and agreed treatment goals.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Dinh, Truc Sophia UNSPECIFIED orcid.org/0000-0002-9774-6751 UNSPECIFIED Brueckle, Maria-Sophie UNSPECIFIED UNSPECIFIED UNSPECIFIED Gonzalez-Gonzalez, Ana Isabel UNSPECIFIED orcid.org/0000-0001-7167-4211 UNSPECIFIED Fessler, Joachim UNSPECIFIED UNSPECIFIED UNSPECIFIED Marschall, Ursula UNSPECIFIED UNSPECIFIED UNSPECIFIED Schubert-Zsilavesz, Manfred UNSPECIFIED UNSPECIFIED UNSPECIFIED Gerlach, Ferdinand M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Harder, Sebastian UNSPECIFIED UNSPECIFIED UNSPECIFIED van den Akker, Marjan UNSPECIFIED orcid.org/0000-0002-1022-8637 UNSPECIFIED Schubert, Ingrid UNSPECIFIED orcid.org/0000-0002-2191-1773 UNSPECIFIED Muth, Christiane UNSPECIFIED orcid.org/0000-0001-8987-182X UNSPECIFIED
URN:	urn:nbn:de:hbz:38-686782
DOI:	10.3390/jpm12010069
Journal or Publication Title:	J. Pers. Med.
Volume:	12
Number:	1
Date:	2022
Publisher:	MDPI
Place of Publication:	BASEL
ISSN:	2075-4426
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language OLDER-ADULTS Multiple languages Health Care Sciences & Services; Medicine, General & Internal Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/68678