Kroenke LTCK, Pinholt EM. Reducing polypharmacy in the elderly. A controlled trial of physcian feedback. Journal of the American Geriatrics Society 1990;38:31-36
PubMed link: https://www.ncbi.nlm.nih.gov/pubmed/2404053
| Methods | Study design: Prospective cohort study
Number of groups: Two groups |
| Participants | Number of participants: 79 enrolled
· Intervention deprescribing group: 38 enrolled · Control group: 41 enrolled Age: 72.3 years Sex: 32 female, 47 male Participants with dementia: No Inclusion criteria: · 65 years of age or older · Seen by internal medicine house staff Exclusion criteria: · Not described Concomitant medicines: 6.7 ± 3.8 Country: United States of America Setting: Hospital – Internal Medicine Clinic at Brooke Army Medical Center, a 692-bed teaching hospital |
| Interventions | Medicines: Polypharmacy
Withdrawal schedule: Not described Comparator: Usual care Method to identify targets: Patient-specific intervention: medication review: Recommendation by two doctors after pharmacist medication reconciliation Recommendation to internal medicine house-staff Tool to identify deprescribing targets: Doctor’s choice (no list, criteria, or tool used) |
| Outcomes | Mean number of medicines
Daily dose |
| Dates | Dates: September 1992 through April 1994
Follow-up duration: Six months |
| Funding sources | Not described |
| Notes |
Risk of bias table
| Bias | Authors’ judgment | Support for judgment |
| Random sequence generation (selection bias) | High risk | Allocation was based on the clinic that participants visited. |
| Allocation concealment (selection bias) | High risk | The study was not concealed.
“House staffs were not formally made aware of the existence of a study. Rather, recommendations were explained as part of an effort to simplify drug regimens, thereby reducing the potential hazards of geriatric polypharmacy.” |
| Blinding of participants and personnel (performance bias) | 5 out of 5 | The study does not appear to have blinded. |
| Blinding of outcome assessment (detection bias) | 5 out of 5 | As above. |
| Incomplete outcome data (attrition bias) | 5 out of 5 | Analysis is as-treated. Although drop-outs are given it is not stated to which group they were originally allocated. However, although these 10 patients did not complete the study, it appeared the two groups remained balanced. |
| Selective reporting (reporting bias) | 1 out of 5 | The study is designed to investigate if it is possible to reduce polypharmacy. The authors have reported on this outcome. Outcomes were not pre-specified. The intervention was aimed at reducing prescription drugs. |
| Confounding (non-randomized) | 5 out of 5 | The study states that the physician was the unit of interest, yet reports on the patients as the unit of interest. It does not take in to account that one physician would treat multiple patients, which potentially confounds the outcomes. Further, the methods were described briefly,so it is not difficult to draw detailed conclusions. For example, the physicians’ baseline details are not given. |
| Other bias | Unclear risk | The follow-up duration is not stated. |
| Newcastle-Ottawa scale | ||
| Selection bias | Representativeness of the exposed cohort | Somewhat representative of older adults taking >=5 medications. |
| Selection of the non-exposed cohort | Control group was drawn from the same community as the exposed cohort.
|
|
| Ascertainment of exposure | Ascertainment of exposure was by written self-report.
|
|
| Demonstration that outcome of interest was not present at start of study | The outcome of interest was demonstrated not to be present at the start of the study. | |
| Comparability bias | Comparability of cohorts on the basis of the design or analysis | The study controls for the clinic that the patient attends. |
| Outcome bias | Assessment of outcome | There was insufficient detail of the method of outcome assessment. |
| Was follow-up long enough for outcomes to occur | Follow-up duration was probably sufficient for the outcomes of interest to occur. | |
| Adequacy of follow-up of cohorts | Follow-up percentage was probably insufficient, and insufficient description of those lost to follow-up. | |
Leave a Reply