Polypharmacy in chronic diseases–Reduction of Inappropriate Medication and Adverse drug events in older populations by electronic Decision Support. Individuals with central nervous system disease or injury have a much higher risk of loss of bowel control and severe constipation than other. Commonly associated with sepsis, cardiovascular collapse, congestive heart failure, major surgery, nephrotoxins (such as antibiotics, intravenous contrast.
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This avoids issues of a potential trade-off between these two forms of event and also allows all patients to be included in the primary analysis. Fluid overload, hyperkalaemia, hyperphosphataemia, metabolic acidosis, and elevated urea nitrogen are common. QualityMetric Incorporated: We envisage that this will kick-start a process of continuous development of new guidelines specifically addressing drug treatments in the context of multimorbidity. It can be very difficult to treat constipation without causing bowel leakage, or to prevent bowel leakage without causing constipation.
Trampisch, Email: Anja Rieckert, Email: Giuliano Piccoliori, Email: Maria Flamm, Email: Tim Johansson, Email: Aneez Esmail, Email: David Reeves, Email: Renate Klaassen-Mielke, Email: Hans Joachim Trampisch, Email: Ilkka Kunnamo, Email: National Center for Biotechnology Information , U.
Journal List Trials v. Published online Jan Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received Aug 28; Accepted Jan This article has been cited by other articles in PMC.
Abstract Background Multimorbidity is increasing in aging populations with a corresponding increase in polypharmacy as well as inappropriate prescribing. Discussion The principal hypothesis is that reduction of polypharmacy and inappropriate prescribing can improve the clinical composite outcome of hospitalization or death. Electronic supplementary material The online version of this article doi: Polypharmacy, Electronic decision support, Primary care, Multimorbidity, Inappropriate prescribing, Randomized controlled trial.
Objectives of the study Our principal hypothesis is that the reduction of polypharmacy and inappropriate prescribing will improve clinical outcomes for older patients.
Open in a separate window. Ethics approval The study has been approved by the five local ethics committees: Setting The PRIMA-eDS trial will be located in the primary care setting including community as well as nursing home resident older patients taking at least eight drugs active ingredients with a systemic effect, combination drugs are counted according to the number of active ingredients.
Table 2 Study centres and settings of the trial. Blinding Inherent to the study protocol GPs and patients cannot be blinded. Indication and contraindication check for all prescribed drugs according to the diagnoses provided and the officially approved indications by the European Medicines Agency EMA Forty rules and recommendations based on systematic reviews of clinical trial and observational study evidence on usage of the most commonly prescribed drugs in older patients [ 30 ] Ninety-five rules and recommendations taken from the Evidence-Based Medicine electronic Decision Support EBMeDS database http: Control GPs in the control group will be asked to record the medication and other data of the participating patients at the same time points as the intervention group.
The GP can then decide whether to perform the laboratory examination or not Smoking behavior Medical procedures e.
Monitoring Monitoring is performed according to a prespecified monitoring charter. Primary outcome The primary outcome is a composite endpoint of first non-elective hospital admission or death during the observation period measured as a binary outcome. Secondary outcome Secondary endpoints are all cause mortality, non-elective hospital admission number of episodes and duration , falls number and severity , fractures, quality of life SFv2 , the number and types of drugs total number, number discontinued, number not discontinued despite the recommendation to discontinue, number re-administered for symptom control , adverse event rate, and medication costs over the observation period.
Potential harms and patient safety We do not expect any specific complications or harms for patients because only non-evidence-based medications will be discontinued. Statistical analysis Statistical analyses are elaborated in a prespecified statistical analysis plan.
Dissemination policy All results of the trial will be published according to a dissemination plan submitted to the EU with the submission of the proposal. Discussion Current knowledge about optimal drug treatment in older patients with multiple chronic conditions is very limited and the PRIMA-eDS trial can potentially make a substantial contribution in this area. Limitations of the study We have explicitly decided to not include any recommendations in the PRIMA-eDS tool for starting patients on additional drugs, and this may be considered a weakness of our study.
Trial status Recruitment started in January and is expected to be completed by 30 September, Additional file Additional file 1: Competing interests The authors declare that they have no competing interests. References 1. Prevalence of chronic diseases and multimorbidity among the elderly population in Sweden. Am J Public Health.
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It provides relief from distressing symptoms including. Hospice care , care at the end of life, always includes palliative care. But you may receive palliative care at any stage of an illness. The goal is to make you comfortable and improve your quality of life. You Are Here: Palliative Care. On this page Basics Summary Start Here. Learn More Related Issues Specifics. Research Clinical Trials Journal Articles.
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