Polypharmacy in chronic diseases: Reduction of Inappropriate Medication and Adverse drug events in elderly populations by electronic Decision Support (PRIMA-eDS)

Chronic multimorbidity is rising in our aging population, and inappropriate polypharmacy of older patients poses a serious threat to health and wellbeing. Furthermore it involves extensive costs in all health care systems. While there exists only limited evidence regarding the benefit of polypharmacy, the evidence regarding potential harm of inappropriate medication is increasing. This clearly indicates that there is a strong need to reduce inappropriate drug therapy and polypragmatic drug prescription. Diverse heterogeneous approaches to reduce polypharmacy and inappropriate prescribing have been proposed, but none of these have been evaluated regarding practicability in primary care and clinically relevant endpoints within a sufficiently powered randomized controlled trial. This leads us to our principal hypothesis that

The reduction of polypharmacy and inappropriate prescribing according to current best evidence will improve the clinical outcome of elderly patients with multiple chronic diseases.

This hypothesis needs to be tested in a sufficiently powered randomized controlled trial with relevant clinical outcome as primary endpoint. PRIMA-eDS is setting out to first gather current best evidence regarding drug treatment of multimorbid elderly patients, and then test the hypothesis stated above in a thoroughly planned randomized controlled trial with hospital admission rate and mortality as primary clinical outcomes.

The objectives of our project to optimise management of elderly patients with multiple chronic diseases and polypharmacy are:

• to carry out a systematic review of the literature, evaluating and defining current best evidence regarding the treatment of elderly patients with multiple chronic diseases, specifically addressing the problem of polypharmacy in the treatment of the most common chronic diseases in elderly populations
• to develop an electronic decision support tool (eDS-tool) to aid physicians and patients to make use of current best evidence when coming to a shared decision regarding multiple drug treatment of the most common chronic diseases in elderly populations
• to test the efficacy of the eDS-tool in an appropriately powered, multinational, multicentre cluster-randomised controlled trial with a composite of hospital admission and mortality as the primary endpoint, and mortality and adverse drug events as safety endpoints
• to optimise the eDS-tool with the results of the randomised controlled trial, and make it available for widespread use within and outside of Europe