title: Outcome prioritisation tool for medication review in older patients with multimorbidity: a pilot study in general practice.
abstract: BACKGROUND
  Several methods have been developed to conduct and support medication reviews in older persons with multimorbidity. Assessing the patient's priorities for achieving specific health outcomes can guide the medication review process. Little is known about the impact of conducting such assessments.
  
  
  OBJECTIVE
  This pilot study aimed to determine proposed and observed medication changes when using an outcome prioritisation tool (OPT) during a medication review in general practice.
  
  
  METHODS
  Participants were older patients with multimorbidity (aged ≥69 years) with polypharmacy (five or more chronic medications) from the practices of 14 GPs.
  
  
  METHODS
  Patients were asked to prioritise four universal health outcomes - remaining alive, maintaining independence, reducing pain, and reducing other symptoms - using an OPT. GPs used this prioritisation to review the medication and to propose and discuss medication changes with the patient. The outcomes included the proposed medication change as documented by the GP, and the observed medication change in the electronic health record at follow-up. Descriptive analyses were conducted to determine medication changes according to the prioritised health outcomes.
  
  
  RESULTS
  A total of 59 patients using 486 medications prioritised the four health outcomes. GPs proposed 34 changes of medication, mainly stopping, for 20 patients. At follow-up, 14 medication changes were observed for 10 patients. The stopping of medication (mostly preventive) was particularly observed in patients who prioritised 'reducing other symptoms' as most important.
  
  
  CONCLUSIONS
  Using an OPT leads mainly to the stopping of medication. Medication changes appeared to be easiest for patients who prioritised 'reducing other symptoms' as most important.
authors.affiliation: Department of General Practice, University of Groningen, University Medical Center Groningen, the Netherlands.
authors.forename: Jojanneke Jgt
authors.initials: JJ
authors.lastname: van Summeren
authors.affiliation: Department of General Practice, University of Groningen, University Medical Center Groningen, the Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Schuling
authors.affiliation: Drug Utilisation Studies, University of Groningen, University Medical Center Groningen, the Netherlands.
authors.forename: Flora M
authors.initials: FM
authors.lastname: Haaijer-Ruskamp
authors.affiliation: Drug Utilisation Quality, Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, the Netherlands.
authors.forename: Petra
authors.initials: P
authors.lastname: Denig
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002908:Chronic Disease / Q000188:drug therapy*; D020000:Decision Support Systems, Clinical; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D054539:Medication Therapy Management / Q000458:organization & administration; D000076322:Multimorbidity; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care; D010865:Pilot Projects; D019338:Polypharmacy; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D058996:Quality Improvement
keywords: decision aid; general practice; medication review; multimorbidity; patient preference; polypharmacy