Baseline characteristics and external validity of older multimorbid patients with polypharmacy and general practitioners enrolled in a randomized controlled primary care trial

Katharina Tabea Jungo, Rahel Meier, Fabio Valeri, Nathalie Schwab, Claudio Schneider, Emily Reeve, Marco Spruit, Matthias Schwenkglenks, Nicolas Rodondi, Sven Streit

Keywords: Multimorbidity, polypharmacy, older adults, general practitioners, clinical trial, external validity, baseline characteristics

Multimorbid older adults remain underrepresented in clinical trials, and recruiting general practitioners and their patients for trials is challenging.

Research questions:
This paper aims to describe the baseline characteristics of GPs and patients participating in the ‘Optimizing PharmacoTherapy in older multimorbid adults In primary CAre’ (OPTICA) trial and to compare them to reference cohorts from a Swiss real-world cohort called the ‘Family medicine ICPC Research using Electronic medical records’ (FIRE) project. It also investigates patients’ willingness to have medications deprescribed.

In this cross-sectional study, 323 multimorbid (≥3 chronic conditions) patients with polypharmacy (≥5 regular medications) aged ≥65 years and 43 GPs recruited for the OPTICA trial were compared to 22,907 older multimorbid patients with polypharmacy and 227 GPs from the FIRE database. We described patients’ baseline willingness to have medications deprescribed using the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire.

The GPs in the FIRE project and OPTICA trial were similar in terms of sociodemographic characteristics and their work as a GP (e.g. aged in their 50s, ≥10 years of experience, ≥60% self-employed, and ≥80% work in group practices). The median age of patients in the OPTICA trial was 77 years and 45% of trial participants were women. Patients participating in the OPTICA trial and patients in the FIRE database were comparable in terms of age, certain clinical characteristics (e.g. systolic blood pressure, body mass index) and health services use (e.g. selected lab and vital data measurements). More than 80% of older multimorbid patients reported to be willing to stop ≥1 of their medications if their doctor said this was possible.

The characteristics of patients and GPs recruited to the OPTICA trial are relatively comparable to characteristics of a real world population, indicating that the findings of the OPTICA trial will have a good external validity. Most patients were open to deprescribing.

Points for discussion:
How can we facilitate the recruitment of general practitioners for research?

How can we facilitate the recruitment of older adults with multimorbidity for research?