[Zurück zur Trefferliste]

RIME - Reduction of inappropriate medication in elderly primary care patients

A cluster-ramdomised controlled trial

 

Projektkennung VfD_RIME_11_001905
Laufzeit von 01/2011 bis 12/2014
Webseitehttp://www.priscus.net
Status des Projekts laufend
GesamtprojektVerbundprojekt PRISCUS II: Entwicklung eines Modells zur gesundheitlichen Versorgung älterer Menschen mit mehrfachen Erkrankungen
ProjektkuerzelRIME

 

Projektbeschreibung

Fragestellung(en) Die clusterrandomisierte kontrollierte RIME Studie testet, ob eine Multikomponentenintervention in Hausarztpraxen den Anteil unangemessener Medikation bei hausärztlich versorgten älteren Patienten reduzieren kann – verglichen mit einer Kontrollintervention, die nur allgemeine Empfehlungen enthält. Ziel ist es, die Medikationsqualität bei älteren Patienten in der hausärztlichen Versorgung zu verbessern.
Hintergrund / Ziele There is a significant increase in the proportion of elderly people living in industrialised countries. Old age is associated with multimorbidity, i.e. an increased number of chronic conditions occurring in the same person. Consequently, elderly people receive the highest share of all drugs prescribed. In Germany, members of the statutory health fund aged 60 years and older represent only 26.8 percent of the total population, but they receive 66 percent of prescribed medications in 2008. Similar data have been presented e.g. for the United Kingdom, Sweden, or United States. Polypharmacy imposes them to a high risk for drug-related problems like drug-drug interactions and adverse drug reactions (ADR).
Consequently, certain drugs are classified as potentially inappropriate medication (PIM) due to their increased risk for causing adverse drug reactions in elderly patients. During the last years efforts have been undertaken to characterise and define potentially inappropriate medication and prescribing criteria on national levels.
Although it has not unanimously been demonstrated that the use of PIM drugs is associated with an increased risk for ADRs or that avoidance of PIM results in a reduced risk for ARDs, most health agencies and scientific associations recommend use of PIM lists for the assessment of prescribing quality in elderly patients. A current study confirmed that inappropriate medication users had an increased risk of falling.
Since PIM lists or explicit prescribing criteria cannot easily be transferred between countries due to differences in drug availability and prescribing behaviour, we have developed a German PIM-list, the PRISCUS-list, which shall be further developed and implemented in the second funding period (20, Progress Report SP3).

Besides the avoidance of high-risk drugs, it is essential to develop new strategies to reduce medication-related risks in a manageable and practicable way. As highlighted by Steinman and co-workers, drugs-to-avoid criteria have a high specificity and positive predictive value, but are not suitable to detect the majority of prescribing problems in an individual patient. The “STOPP and START” criteria include clinically relevant criteria for potentially inappropriate prescribing and evidence-based prescribing indicators for commonly encountered diseases in older people. More over, several criteria selected from the Beers list and ACOVE indicators were selected by a recently started intervention study in Norway to improve prescribing for the elderly. Instead of developing drug avoidance criteria, a “positive-list” naming preferred central nervous system medications in older adults, has also been suggested.

Apart from the measures of appropriateness of prescribing, the methods applied to change prescribing have been evaluated in reviews . Several procedures to influence physicians prescribing behaviour have been tested, from simple interventions such as mailings and leaflets to complex interventions including academic detailing, case-vignettes, leaflets and feedback of prescription data – with mixed results. Beyond influencing the prescribing behaviour of family physicians, pharmacist- and nurses-led medication reviews were introduced, but have not yet demonstrated a significant reduction of adverse events such as falls or hospitalisations. The success of an intervention depends not only on the explicit/implicit criteria chosen, but rather on the modification of the whole process of drug prescribing and the acceptance of any intervention.

In the second funding period we aim to extract the most relevant “do’s and don’ts” from the PRISCUS-list developed in the first funding period and create the PRISCUS short-list, in collaboration with the colleagues from Hannover (SP5) and Bochum (SP1,2). In collaboration with others we will use different approaches to implement these explicit criteria in in community-dwelling elderly. Primary goal is the modification of prescribing behaviour according to pre-defined explicit criteria such as number of PIM-prescriptions, major drug-drug interactions and appropriate monitoring of high-risk drugs in the elderly.
Based on the PRISCUS short-list an intervention in primary care will follow, conducted as a cluster-randomised clinical trial (RIME).
Methodik Entwicklung der PRISCUS Short-list
Auswahl von Arztpraxen
Durchführung eines RCT
Datenbasis Primärdaten
   Befragung telefonisch  (Stichprobengröße: k.A.)
   Interview (Face to face)  (Stichprobengröße: k.A.)
   Experiment  (Stichprobengröße: k.A.)
Studiendesign Randomisierte kontrollierte Studie (RCT)
Untersuchte Geschlechter weiblich und männlich
Untersuchte Altersgruppen von 65 bis 100 Jahre
Ergebnisse --

Forschende und kooperierende Einrichtungen

Projektverantwortliche

Förderung

Veröffentlichungen

Schlagwörter

 

Stand: 15.08.2012