Collaborative medication reviews during acute primary care admissions for older adults with polypharmacy: a randomised controlled trial

Abstract Background Polypharmacy in older adults is associated with inappropriate prescribing and adverse drug events. In a previous trial, we demonstrated improved Health-Related Quality of Life (HRQoL) following medication reviews by geriatricians and general practitioners in home-dwelling older adults. Whether similar benefits can be achieved during acute admissions in primary care remains unclear. Objective To assess the effect of collaborative medication reviews during acute admissions to a Municipal Inpatient Acute Care (MIPAC) unit. Methods In this single-blind, parallel-group, randomised controlled trial, patients ≥70 years using ≥6 regular medications admitted to a MIPAC unit in Oslo, Norway, were randomised 1:1 to receive either a structured medication review or usual care. The intervention involved assessment by MIPAC physicians specialised in general practice, geriatric supervision and discussion with the patient’s general practitioner. The primary outcome was HRQoL measured with the 15D instrument at 16 weeks. Secondary outcomes included physical and cognitive function, oral health, healthcare utilisation and mortality. Results We included 137 participants (mean age 85 years, 69% women; 67 intervention, 70 control). At 16 weeks, there was no significant difference in 15D scores between groups (mean difference 0.009; 95% CI, −0.063 to 0.079; P = .8). The intervention group had more medication changes during admission, but differences diminished post-discharge. No differences were observed in secondary outcomes. Conclusion Collaborative medication reviews during acute primary care admissions did not improve HRQoL. The findings underscore the need for longitudinal, patient-centred strategies initiated in clinically stable phases.