MultiPAP Plus: Improving Prescription in Primary Care Patients With Multimorbidity and Polypharmacy
Condition: Multimorbidity; Polypharmacy; Comorbidities and Coexisting Conditions; Clinical Decision-Support Systems
Study type: Interventional

Summary: 
      This study assesses the effectiveness of a complex intervention in young-old patients with
      multimorbidity and polypharmacy aimed at improving physician drug prescription in primary
      care, measured by hospitalization-mortality at six 6 (T1), 12 (T2) and 18 (T3) months from
      baseline compared to usual care.
    

Detailed description: 
      Design: Pragmatic cluster randomized clinical trial with 18 months follow-up.

      Unit of randomization: general practitioner.

      Unit of analysis: patient.

      Setting: Primary Health Care Centres in three different Spanish Autonomous Communities
      (Aragón, Madrid and Andalucía).

      Population: Patients 65-74 years of age with multimorbidity (3 or more chronic diseases) and
      polypharmacy (5 or more drugs taken for at least three months). N=1234 patients (617 in each
      arm, 8 patients per physician) will be recruited by general practitioners before
      randomization.

      Intervention: Complex intervention incorporating previous MultiPAP intervention (based on the
      ARIADNE principles with two main components: 1) Training of general practitioners and 2)
      Patient-centered clinical interview) And it adds a clinical-decision support system to help
      structured treatment-plan review.

      Control group: usual care.

      Variables: First level (Patient): a) Main: hospitalizations and/or mortality; b) Secondary:
      health services use, quality of life (Euroqol 5D-5L), disability (WHODAS), fractures,
      pharmacotherapy and adherence to treatment (Morisky-Green), clinical and socio-demographic.
      Second level (Physician): a) Socio-demographic. b) CDSS use: acceptance and satisfaction of
      health care provider use c) Professional background: time in the position, center
      characteristics and medical education involvement.

      Analysis: All analyses will be carried out adhering to the intention-to-treat principle.
      Description of baseline characteristics. Basal comparison between groups. Analysis of primary
      outcome: difference in percentages in the final combined variable from 0 (T0) to 18 months
      (T3), with its corresponding 95% CI. Adjustement by main confounding and prognostic factors
      will be performed through a multilevel analysis.
    

Intervention name(s): MultiPAP Plus; Usual care
Intervention type(s): Other; Other
Intervention description(s): Complex intervention incorporating previous MultiPAP intervention (based on the ARIADNE principles with two main components: 1) Training of general practitioners and 2) Patient-centered clinical interview) And it adds a clinical-decision support system to help structured treatment-plan review.; Patients will receive the usual clinical care based on current clinical practice guidelines.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Health Services Research
Keywords: Primary Health Care; Medication Adherence; Disability; Patient-Centered Care; Ariadne Principles