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Evidence-Based Decision Support for a Structured Care Program on Polypharmacy in Multimorbidity: A Guideline Upgrade Based on a Realist Synthesis

Authors :
Group, Truc Sophia Dinh
Maria-Sophie Brueckle
Ana Isabel González-González
Joachim Fessler
Ursula Marschall
Manfred Schubert-Zsilavesz
Ferdinand M. Gerlach
Sebastian Harder
Marjan van den Akker
Ingrid Schubert
Christiane Muth
the EVITA Study Group the EVITA Study
Source :
Journal of Personalized Medicine; Volume 12; Issue 1; Pages: 69
Publication Year :
2022
Publisher :
Multidisciplinary Digital Publishing Institute, 2022.

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.

Details

Language :
English
ISSN :
20754426
Database :
OpenAIRE
Journal :
Journal of Personalized Medicine; Volume 12; Issue 1; Pages: 69
Accession number :
edsair.multidiscipl..89a265390b79d408a9134e87ffad1db9
Full Text :
https://doi.org/10.3390/jpm12010069