A Swiss Interprofessional Network for Reviewing Inappropriate Medication in Primary Care
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Medication review.
- Who it may be relevant to
- Registry conditions: Medication Review, Primary Care. Basic parameters: from 65 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Switzerland
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Official title
A Swiss Interprofessional Network for Reviewing Inappropriate Medication in Primary Care: a Pilot Study
Overview
The aim of the SINERGIC pilot study is to assess the feasibility in the Swiss context of implementing interprofessional medication reviews between GP and pharmacists, as part of a shared decision-making process with patients. The acceptability and potential effectiveness of such an intervention will also be assessed. This assessment will enable the investigators to take into account the determining factors for setting up a large-scale study to support the sustainable financing of this service in the long term.
Detailed description
The ageing population is leading to an increase in the prevalence of chronic conditions among older adults, often resulting in excessive polypharmacy. Polypharmacy, as well as the prescription of high-risk medications in this population, exposes them to more adverse effects, which can lead to falls and hospitalisation. This problem is of concern to healthcare professionals, whether they be general practitioners (GP), who have an overview of medical records, or dispensing pharmacists, who have an overview of medication. In Switzerland, these two professions still operate often in isolation from each other, but genuine collaboration is essential if we are to improve and manage polypharmacy among the elderly and limit the risks. Medication reviews are recognised as promising strategies for improving the quality of prescribing in patients with multiple medications.
This pilot trial does not randomly select participants and does not include a control group. It is a hybrid study that aims both to test the effectiveness of the intervention and to prepare for its implementation.
The study plans to include at least 250 patients from three groups of general practices in different settings. Participants will be aged 65 or older, take at least five chronic medications, and suffer from at least three chronic conditions. Individuals living in medical institutions will not be included.
Intervention:
* Step 1 (optional): Patients taking at least 10 chronic medications and experiencing adherence or side effect issues may benefit from a specialised consultation with a pharmacist. * Step 2: The pharmacist identifies any medication-related issues for each patient and discusses them directly with the general practitioner in order to agree on the necessary adjustments. * Step 3: During a medical appointment, the doctor and patient will decide together whether to implement the proposed changes. * Step 4: The pharmacist will follow up after a few days and then again after 3 months.
Main objective: To assess whether this service is feasible in the context of the study.
Secondary objectives: Measure whether the intervention is well accepted (questionnaires and interviews) by the patients and healthcare professionals involved.
Exploratory objectives: Study the impact of the intervention on the quality of drug treatments, patients' quality of life and drug costs.
Interventions
- Other Medication review
* Step 1 (optional): Patients taking at least 10 chronic medications and experiencing adherence or side effect issues may benefit from a specialised consultation with a pharmacist. * Step 2: The pharmacist identifies any medication-related issues for each patient and discusses them directly with the general practitioner in order to agree on the necessary adjustments. * Step 3: During a medical appointment, the doctor and patient will decide together whether to implement the proposed changes. * S
Primary outcome measures
- Number of participants recruited and percentage of participants retained [Time frame: End of the study, expected to be on average after 4-6 months]
- Number of GPs recruited and percentage of GPs retained [Time frame: End of the study, expected to be on average after 18 months]
Secondary outcome measures (7)
- Score of participants' acceptability of the intervention (Patients Reported Experience Measures) [Time frame: End of the study, expected to be on average after 4-6 months]
- Score of the healthcare professionals' acceptability of the intervention [Time frame: End of the study, up to 18 months]
- Qualitative evaluation of healthcare professionals' acceptability [Time frame: End of the study, up to 18 months]
- Number and percentage of clinically relevant drug related problems resolved [Time frame: 3 months after medical consultation]
- Amount of drug cost savings [Time frame: 3 months after medical consultation]
- Cost of the service [Time frame: During interprofessional meeting between GP and pharmacist]
- Score on health-related quality of life (Patient-Reported Outcomes Measures or PROMs) [Time frame: 3 months after medical consultation]
Eligibility criteria
Inclusion criteria
- Age ≥ 65 years old;
- Regular use of at least 5 medications (chronic treatments, > 3 months);
- Patients with a minimum of 3 chronic diseases;
- Regular follow-up in a GP practice taking part in the project;
- Adequate understanding of French.
- Written informed consent
Exclusion criteria
- Residence in an institution (residential care facility, nursing home, etc.) ;
- Cognitive impairment preventing understanding or obtaining informed consent;
- Any other clinical situation deemed incompatible with participation, as decided by the GP in charge.
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: Yes
Study design
- Allocation
- N/A
- Model
- Single group
- Masking
- Open label
- Primary purpose
- Health services research
Study locations
Switzerland · 1 center
- Institute of Primary Health Care (BIHAM) — Bern
Publications
- Mallet L, Spinewine A, Huang A. The challenge of managing drug interactions in elderly people. Lancet. 2007 Jul 14;370(9582):185-191. doi: 10.1016/S0140-6736(07)61092-7. PMID 17630042
- Liew TM, Lee CS, Goh SKL, Chang ZY. The prevalence and impact of potentially inappropriate prescribing among older persons in primary care settings: multilevel meta-analysis. Age Ageing. 2020 Jul 1;49(4):570-579. doi: 10.1093/ageing/afaa057. PMID 32365168
- Cole JA, Goncalves-Bradley DC, Alqahtani M, Barry HE, Cadogan C, Rankin A, Patterson SM, Kerse N, Cardwell CR, Ryan C, Hughes C. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2023 Oct 11;10(10):CD008165. doi: 10.1002/14651858.CD008165.pub5. PMID 37818791
Identifiers
NCT: NCT07283055 · SINERGIC_01