Evidence map›Paper›PMID 37225248›Full record

Trial reportBMJ (Clinical research ed.)2023

Optimising prescribing in older adults with multimorbidity and polypharmacy in primary care (OPTICA): cluster randomised clinical trial.

Katharina Tabea Jungo, Anna-Katharina Ansorg, Carmen Floriani, Zsofia Rozsnyai, Nathalie Schwab, Rahel Meier, Fabio Valeri, Odile Stalder, Andreas Limacher, Claudio Schneider and 6 more

Registry-linked trialOpen access · hybridAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ (Clinical research ed.), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03724539 (Optimizing PharmacoTherapy In the Multimorbid Elderly in Primary CAre), which is not on this map. Cited by 24 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
24citing papers in PubMed, 7 pooled it
7.7field-weighted citation impact, top 2% 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.

NCT03724539 nacompletednot on this map

Optimizing PharmacoTherapy In the Multimorbid Elderly in Primary CAre: a Cluster Randomized Controlled Trial (the OPTICA Trial)

TypeinterventionalSponsorUniversity of BernRan2019 to 2021Enrolled323ConditionsMultimorbidity, PolypharmacyArmsSTRIPA intervention, Sham intervention
3 · Its place in the literature

Who cites it

24 citing papers in PubMed, 7 syntheses or guidelines pooled it, 43 citations in OpenAlex.

  1. Pooled it
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  4. Patient and family engagement interventions in primary care patient safety: systematic review and meta-analysis of randomised controlled trials.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025
    Pooled it
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  6. Pooled it
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  8. Trial
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  11. Article
  12. Observational
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  17. Multimorbidity Management: A Scoping Review of Interventions and Health Outcomes.International journal of environmental research and public health · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors at 4 institutions in 2 countries.

Katharina Tabea JungoInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.ORCID 0000-0002-1782-1345
Anna-Katharina AnsorgInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Carmen FlorianiInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Zsofia RozsnyaiInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Nathalie SchwabInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Rahel MeierInstitute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland.
Fabio ValeriInstitute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland.
Odile StalderCTU Bern, University of Bern, Bern, Switzerland.
Andreas LimacherCTU Bern, University of Bern, Bern, Switzerland.
Claudio SchneiderDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Michael Bagattinimfe Haus and Kinderärzte Schweiz, Bern, Switzerland.
Sven TrelleCTU Bern, University of Bern, Bern, Switzerland.
Marco SpruitDepartment of Information and Computing Sciences, Utrecht University, Utrecht, Netherlands.
Matthias SchwenkglenksInstitute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland.
Nicolas RodondiInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Sven StreitInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland sven.streit@biham.unibe.ch.ORCID 0000-0002-3813-4616
University of Bern · CHUniversity of Zurich · CHLeiden University · NLUniversity of Basel · CH

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo study the effects of a primary care medication review intervention centred around an electronic clinical decision support system (eCDSS) on appropriateness of medication and the number of prescribing omissions in older adults with multimorbidity and polypharmacy compared with a discussion about medication in line with usual care.

designCluster randomised clinical trial.

settingSwiss primary care, between December 2018 and February 2021.

participantsEligible patients were ≥65 years of age with three or more chronic conditions and five or more long term medications.

interventionThe intervention to optimise pharmacotherapy centred around an eCDSS was conducted by general practitioners, followed by shared decision making between general practitioners and patients, and was compared with a discussion about medication in line with usual care between patients and general practitioners.

main outcome measuresPrimary outcomes were improvement in the Medication Appropriateness Index (MAI) and the Assessment of Underutilisation (AOU) at 12 months. Secondary outcomes included number of medications, falls, fractures, and quality of life.

resultsIn 43 general practitioner clusters, 323 patients were recruited (median age 77 (interquartile range 73-83) years; 45% (n=146) women). Twenty one general practitioners with 160 patients were assigned to the intervention group and 22 general practitioners with 163 patients to the control group. On average, one recommendation to stop or start a medication was reported to be implemented per patient. At 12 months, the results of the intention-to-treat analysis of the improvement in appropriateness of medication (odds ratio 1.05, 95% confidence interval 0.59 to 1.87) and the number of prescribing omissions (0.90, 0.41 to 1.96) were inconclusive. The same was the case for the per protocol analysis. No clear evidence was found for a difference in safety outcomes at the 12 month follow-up, but fewer safety events were reported in the intervention group than in the control group at six and 12 months.

conclusionsIn this randomised trial of general practitioners and older adults, the results were inconclusive as to whether the medication review intervention centred around the use of an eCDSS led to an improvement in appropriateness of medication or a reduction in prescribing omissions at 12 months compared with a discussion about medication in line with usual care. Nevertheless, the intervention could be safely delivered without causing any harm to patients.

trial registrationNCT03724539Clinicaltrials.gov NCT03724539.

Indexed as

PolypharmacyAgedAged, 80 and overFemaleHumansMultimorbidityPrimary Health CareQuality of Life

Identifiers

PMID37225248
PMCPMC10206530
OpenAlexW4377989624

What Socratic holds

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LicenceCC BY
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Registered trials

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.