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Improving medication adherence and effective prescribing through a patient-centered prescription model in patients with multimorbidity

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to assess the impact of the patient-centered prescription (PCP) model in medication adherence and effective prescribing in patients with multimorbidity.

Methods

Uncontrolled before–after study in an intermediate care facility in a mixed urban–rural district. Inpatients aged ≥ 65 years with multimorbidity exposed to polypharmacy before hospital admission were consecutively enrolled. Every patient’s treatment plan was analyzed through the PCP model, which includes interventions aimed at improving medication adherence. The primary endpoint was the change in the proportion of adherent patients between pre-admission and after discharge for all regularly scheduled long-term medications, using the proportion of days covered (PDC). Secondary endpoints included the change on mean PDC for all long-term medications, number of long-term medications, proportion of patients with hyperpolypharmacy, medication regimen complexity index (MRCI) score, drug burden index (DBI) score, number of potential inappropriate prescribing (PIP), and proportion of patients with ≥ 2 PIPs.

Results

Ninety-three non-institutionalized patients were included (mean age 83.0 ± SD 6.1 years). The proportion of adherent patients increased from 22.1 to 51.9% (P < 0.001). Intervention also improved mean PDC [mean difference (95% CI) 10.6 (7.7, 13.5)] and effective prescribing through a reduction on the number of long-term medications [− 1.3 (− 1.7, − 0.9)], proportion of patients exposed to hyperpolypharmacy (− 16.1%, P < 0.001), MRCI score [− 2.2 (− 3.4, − 1.0)], DBI score [− 0.16 (− 1.8, − 1.3)], number of PIPs [− 1.6 (− 1.8, − 1.3)], and proportion of patients with ≥ 2 PIPs (− 53.7%, P < 0.001).

Conclusion

Studied intervention provides significant effective prescribing and medication adherence enhancements in non-institutionalized older patients with multimorbidity and polypharmacy.

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Availability of data and material

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

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Acknowledgements

The authors sincerely thank study participants and their family members for their participation and interest in the study. The assistance of medical and nurse facility staff is gratefully acknowledged, including Mr. Antoni Casals, Mr. Joan Carles Rovira, Mrs. Anna Torné, and Mrs. Anna Ribera. We are also very grateful to Mrs. Jennifer McIntosh for reviewing our manuscript for clarity.

Funding

This study was partially supported by funding provided by the Catalan Society of Clinical Pharmacy through the Route of Excellence awards. The funding organization had no involvement in the study design, data collection, analysis and interpretation, writing of the manuscript, and submission for publication. No other sources of funding were used to assist in the conduct of this study or preparation of this article.

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Authors and Affiliations

  1. Pharmacy Department, Consorci Hospitalari de Vic, Vic, Barcelona, Spain

    J. González-Bueno & C. Codina-Jané

  2. Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain

    J. González-Bueno, D. Sevilla-Sánchez, N. Molist-Brunet, C. Codina-Jané & J. Espaulella-Panicot

  3. Pharmacy Department, Parc Sanitari Pere Virgili, Barcelona, Spain

    D. Sevilla-Sánchez

  4. Epidemiology Unit, Consorci Hospitalari de Vic, Vic, Barcelona, Spain

    E. Puigoriol-Juvanteny

  5. Tissue Repair and Regeneration Laboratory (TR2Lab) Group, Faculty of Sciences and Technology & Faculty of Medicine, University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain

    E. Puigoriol-Juvanteny

  6. Department of Geriatrics, Consorci Hospitalari de Vic & Fundació Hospital de La Santa Creu de Vic, Vic, Barcelona, Spain

    N. Molist-Brunet & J. Espaulella-Panicot

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Contributions

All authors contributed to the study conception and design. González-Bueno J, Sevilla-Sánchez D, Puigoriol-Juvanteny E, and Molist-Brunet N performed material preparation, data collection, and analysis. González-Bueno J wrote the first draft of the manuscript, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to J. González-Bueno.

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Ethics approval

This study (ID: PR223) was approved by the Ethics and Clinical Research Committee of the Osona Foundation for Research and Health Education – Vic Consortium Hospital, Barcelona, Spain. The authors certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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González-Bueno, J., Sevilla-Sánchez, D., Puigoriol-Juvanteny, E. et al. Improving medication adherence and effective prescribing through a patient-centered prescription model in patients with multimorbidity. Eur J Clin Pharmacol 78, 127–137 (2022). https://doi.org/10.1007/s00228-021-03207-9

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