Effectiveness of Integrated Care for Outpatients with Polypharmacy: Evaluating Interventions Using Organization-Based and Novel Incentive-Based Approaches to Improve the Outcomes for Older People

BACKGROUND: Inappropriate polypharmacy is a particular concern in older people and is associated with negative health outcomes. Inappropriate polypharmacy not only drains the healthcare system of resources, but seriously hinders the effectiveness of important treatment innovations. Choosing the best interventions to improve appropriate polypharmacy is a priority, hence there is growing interest in appropriate polypharmacy by evaluating different intervention approaches to achieve better clinical outcomes for patients. METHODS: In study 1, a self-designed Medication-Related Quality of Life Questionnaire will be developed and administered to 200 outpatients. Psychological properties such as reliability will be calculated and criteria validity will be assessed by correlating with the Drug Burden Index. The instruments will be used in the following studies to assess interventional outcomes of elderly with polypharrmacy. In study 2, we study the impact of a pharmacist consult clinic on the care of elderly outpatients with polypharmacy. A randomized controlled study of 120 patients aged 65 years or older with polypharmacy (＞=5 chronic medications) was conducted in a medical center. A clinical pharmacist meets with intervention group patients during pharmacy consultation clinics to evaluate their drug regimens and make recommendations to them and their physicians. Outcome measures are prescribing appropriateness, adverse drug events, medication adherence, number of medications, medication-related quality of life, and patient satisfaction. All patients will be assessed for outcome variables at baseline, 3 months and 6 months later. Study 3, using the same experimental design as Study 2, examines the effectiveness of a newly developed lottery-based incentive approach to adherence of elderly with polypharmacy according to insights from the literature of behavioral economics. Behavioral economics offer a variety of concepts that, when used in the design of interventions to improve medication adherence, may be more successful than traditional approaches. These concepts include 1) Reference dependency: Using mentor elderly to serve as social references who provide temporally salient modeling of utilization of services and adherence to treatment; 2) Present bias of economic incentives: rewarding adherence to polypharmacy leverage present bias because people are generally biased toward immediate versus future awards; 3) Default bias: our preference for the default option could be expanded increase adherence;4) Loss aversion: humans are hardwired to avoid loss more than to pursue an equivalent gain. A total of 60 non-adherence elderly with polypharmacy will be recruited and evenly distributed to the intervention and control group. All the participants will attend the clinics for evaluation of adherence monthly and will be assessed for outcome variables at baseline and 6 months later. CONCLUSION: This study will demonstrate the effectiveness of organization-based and novel incentive-based approaches can reduce inappropriate prescribing and possibly adverse drug effects without adversely affecting health-related quality of life.

Project ID:PF10401-0847
External Project ID:MOST103-2410-H182-023-MY2