Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Rediscovering Public Administration. Creating images from University

Con un enfoque novedoso, este libro recoge las originales aportaciones que un grupo de universitarios españoles han elaborado acerca de la Administración pública en España. El objetivo es transmitir conocimientos desde el ámbito académico a cualquier ciudadano, para alentar la reflexión con criterio nuestras administraciones, sus cambios y sus previsibles dinámicas. También se dirige especialmente al funcionario, que no deja de ser una parte representativa de la sociedad, como una oportunidad para repensar su propia labor y desempeño en los servicios que ofrecen, que garantizan el bienestar de toda la ciudadanía.This book collects, with a novel focus, the original contributions that a group of Spanish university students have produced about Public Administration in Spain. Its goal is to transmit knowledge from the academic sphere to any citizen, in order to encourage a discerning reflection on our administration, its changes and its foreseeable dynamics. It is also aimed to the public servant, who is a representative part of society, as an opportunity to rethink his own labour and performance on the provided services that guarantee the welfare of society.Avec une nouvelle approche, ce livre recueille les contributions originales élaborées par un groupe d’universitaires espagnols à propos de l’Administration Publique en Espagne. Le but est de diffuser des connaissances à n’importe quel citoyen, depuis le cercle académique, afin d’encourager la réflexion sur nos administrations, leurs changements et leurs dynamiques prévisibles. De la même manière, le livre se dirige particulièrement au fonctionnaire, qui n’arrête pas d’être une partie représentative de la société, ainsi qu’une opportunité pour repenser à son propre travail et à son accomplissement sur les services qu’il accomplit, lesquels garantissent le bien-être à toute la citoyenneté.Der vorliegende Text stellt kein Buch zum Gebrauch da, weder in seinem Kern noch in seiner Verfassung, da es beabsichtigt, das positive Konzept der Öffentlichen Verwaltung angesichts von Stereotypen und Vorurteilen wieder herzustellen. Und in der Art der Verfassung, weil aus einer Liste von „vieltalentierten“ Mitteln, oder Bildern, zusammengestellt ist, welche von Studenten erarbeitet wurden, die in der Gesellschaft engagiert sind.Instituto Nacional de Administración PúblicaDepto. de Ciencia Política y de la AdministraciónFac. de Ciencias Políticas y SociologíaTRUEpu