The multimorbidity collaborative medication review and decision making (MyComrade) study: a pilot cluster randomised trial in two healthcare systems
Creators: name: Kirwan, Collette
name: Hynes, Lisa
name: Hart, Nigel
name: Mulligan, Sarah
name: Leathem, Claire
name: McQuillan, Laura
name: Maxwell, Marina
name: Carr, Emma
name: Roche, Kevin
name: Walkin, Scott
name: McCarthy, Caroline
name: Bradley, Colin
name: Byrne, Molly
name: Smith, Susan M.
name: Hughes, Carmel
name: Corry, Maura
name: Kearney, Patricia M
name: McCarthy, Geraldine
name: Cupples, Margaret
name: Gillespie, Paddy
name: Hobbins, Anna
name: Newell, John
name: GLYNN, LIAM
name: Roshan, Davood
name: Sinnott, Carol
name: W Murphy, Andrew
Publisher: name: University of Limerick
Year: 2023
Subjects: subject: Health sciences
subject: FOS: Health sciences

description: Background: While international guidelines recommend medication reviews as part of the management of multimorbidity, evidence on how to implement reviews in practice in primary care is lacking. The MyComrade (MultimorbiditY Collaborative Medication Review And Decision Making) intervention is an evidence-based, theoretically informed novel intervention which aims to support the conduct of medication reviews for patients with multimorbidity in primary care. Aim: The pilot study aimed to assess the feasibility of a defnitive trial of the MyComrade intervention across two healthcare systems (Republic of Ireland (ROI) and Northern Ireland (NI)). Design: A pilot cluster-randomised controlled trial was conducted (clustered at general practice level), using specifc progression criteria and a process evaluation framework. Setting: General practices in the ROI and NI. Participants: Eligible practices were those in defned geographical areas who had GP’s and Practice Based Pharmacists (PBP’s) (in NI) willing to conduct medication reviews. Eligible patients were those aged 18 years and over, with multi morbidity and on ten or more medications. Intervention: The MyComrade intervention is an evidence-based, theoretically informed novel intervention which aims to support the conduct of medication reviews for patients with multimorbidity in primary care, using a planned collaborative approach guided by an agreed checklist, within a specifed timeframe. Outcome measures: Feasibility outcomes, using pre-determined progression criteria, assessed practice and patient ecruitment and retention and intervention acceptability and fdelity. Anonymised patient-related quantitative data, from practice medical records and patient questionnaires were collected at baseline, 4 and 8 months, to inform potential outcome measures for a defnitive trial. These included (i) practice outcomes—completion of medication reviews; (ii) patient outcomes—treatment burden and quality of life; (iii) prescribing outcomes—number and changes of prescribed medications and incidents of potentially inappropriate prescribing; and (iv) economic cost analysis. The framework Decision-making after Pilot and feasibility Trials (ADePT) in conjunction with a priori progression criteria and process evaluation was used to guide the collection and analysis of quantitative and qualitative data. Results: The recruitment of practices (n=15) and patients (n=121, mean age 73 years and 51% female), representing 94% and 38% of a priori targets respectively, was more complex and took longer than anticipated; impacted by the global COVID-19 pandemic. Retention rates of 100% of practices and 85% of patients were achieved. Both practice staf and patients found the intervention acceptable and reported strong fdelity to the My Comrade intervention components. Some practice staf highlighted concerns such as poor communication of the reviews to patients, dissatisfaction regarding incentivisation and in ROI the sustainability of two GPs collaboratively conducting the medication reviews. Assessing outcomes from the collected data was found feasible and appropriate for a defnitive trial. Two progression criteria met the ‘Go’ criterion (practice and patient retention), two met the ‘Amend’ criterion (practice recruitment and intervention implementation) and one indicated a ‘Stop – unless changes possible’ (patient recruitment). Conclusion: The MyComrade intervention was found to be feasible to conduct within two diferent healthcare systems. Recruitment of participants requires signifcant time and efort given the nature of this population and the pairing of GP and pharmacist may be more sustainable to implement in routine practice.