Evidence map›Paper›PMID 32554566›Full record

Trial reportBMJ (Clinical research ed.)2020

Use of an electronic decision support tool to reduce polypharmacy in elderly people with chronic diseases: cluster randomised controlled trial.

Anja Rieckert, David Reeves, Attila Altiner, Eva Drewelow, Aneez Esmail, Maria Flamm, Mark Hann, Tim Johansson, Renate Klaassen-Mielke, Ilkka Kunnamo and 7 more

Open access · hybridAbstract readRandomized Controlled TrialPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ (Clinical research ed.), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 56 papers, 14 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
56citing papers in PubMed, 14 pooled it
11.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

56 citing papers in PubMed, 14 syntheses or guidelines pooled it, 143 citations in OpenAlex.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors at 9 institutions in 5 countries.

Anja RieckertInstitute of General Practice and Family Medicine, Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, 58448 Witten, Germany Anja.Rieckert@uni-wh.de.ORCID 0000-0002-9735-378X
David ReevesNational Institute for Health Research School for Primary Care Research, School of Health Sciences, University of Manchester, UK.ORCID 0000-0001-6377-6859
Attila AltinerInstitute of General Practice, Rostock University Medical Center, Rostock, Germany.
Eva DrewelowInstitute of General Practice, Rostock University Medical Center, Rostock, Germany.
Aneez EsmailNational Institute for Health Research School for Primary Care Research, School of Health Sciences, University of Manchester, UK.ORCID 0000-0001-7061-7434
Maria FlammInstitute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria.
Mark HannCentre for Biostatistics, School for Health Sciences, University of Manchester, UK.ORCID 0000-0002-4508-5584
Tim JohanssonInstitute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria.
Renate Klaassen-MielkeDepartment of Medical Informatics, Biometry and Epidemiology, Ruhr-University Bochum, Germany.
Ilkka KunnamoDuodecim Medical Publications, Helsinki, Finland.
Christin LöfflerInstitute of General Practice, Rostock University Medical Center, Rostock, Germany.
Giuliano PiccolioriInstitute for General Practice of Bolzano, Bolzano, Italy.
Christina SommerauerInstitute of General Practice and Family Medicine, Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, 58448 Witten, Germany.
Ulrike S TrampischInstitute of General Practice and Family Medicine, Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, 58448 Witten, Germany.
Anna VögeleInstitute for Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.
Adrine WoodhamNational Institute for Health Research School for Primary Care Research, School of Health Sciences, University of Manchester, UK.
Andreas SönnichsenNational Institute for Health Research School for Primary Care Research, School of Health Sciences, University of Manchester, UK.ORCID 0000-0003-2733-4062
National Institute for Health Research · GBUniversity of Rostock · DEWitten/Herdecke University · DEParacelsus Medical University · ATEurac Research · ITFinnish Medical Society Duodecim · FIManchester Academic Health Science Centre · GBOspedale di Bolzano · ITZimmer Biomet (Germany) · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo evaluate the effects of a computerised decision support tool for comprehensive drug review in elderly people with polypharmacy.

designPragmatic, multicentre, cluster randomised controlled trial.

setting359 general practices in Austria, Germany, Italy, and the United Kingdom.

participants3904 adults aged 75 years and older using eight or more drugs on a regular basis, recruited by their general practitioner.

interventionA newly developed electronic decision support tool comprising a comprehensive drug review to support general practitioners in deprescribing potentially inappropriate and non-evidence based drugs. Doctors were randomly allocated to either the electronic decision support tool or to provide treatment as usual.

main outcome measuresThe primary outcome was the composite of unplanned hospital admission or death by 24 months. The key secondary outcome was reduction in the number of drugs.

results3904 adults were enrolled between January and October 2015. 181 practices and 1953 participants were assigned to electronic decision support (intervention group) and 178 practices and 1951 participants to treatment as usual (control group). The primary outcome (composite of unplanned hospital admission or death by 24 months) occurred in 871 (44.6%) participants in the intervention group and 944 (48.4%) in the control group. In an intention-to-treat analysis the odds ratio of the composite outcome was 0.88 (95% confidence interval 0.73 to 1.07; P=0.19, 997 of 1953

conclusionsIn intention-to-treat analysis, a computerised decision support tool for comprehensive drug review of elderly people with polypharmacy showed no conclusive effects on the composite of unplanned hospital admission or death by 24 months. Nonetheless, a reduction in drugs was achieved without detriment to patient outcomes.

trial registrationCurrent Controlled Trials ISRCTN10137559.

Indexed as

Decision Support Systems, ClinicalPolypharmacyAged, 80 and overAustriaChronic DiseaseCluster AnalysisDeprescriptionsDrug Utilization ReviewFemaleGeriatric AssessmentGermanyHumansInappropriate PrescribingItalyMaleUnited Kingdom

Identifiers

PMID32554566
PMCPMC7301164
OpenAlexW3036625496

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.