- Design
- Pragmatic cluster-randomised controlled trial with process evaluation
- Population
- 60 adults aged ≥65 on >4 long-term medicines, 6 Welsh practices
- Primary outcome
- Clinical problems addressed
- Effect
- More than one problem addressed 82% vs 35%, aOR 7.48 (1.99–28.1)
A pragmatic cluster-randomised trial in PLoS One (18 September) tested the Adverse Drug Reaction (ADRe) Profile in six general practices in South-West Wales. Patients aged 65 or over on more than four long-term medicines completed a structured checklist of possible drug-related symptoms, which was passed to the practice pharmacist; controls had usual care. Sixty patients took part.
Intervention patients were far more likely to have more than one clinical problem addressed (22/27, 82%, vs 11/30, 35%; adjusted OR 7.48, 95% CI 1.99–28.1). Two findings were important: vitamin B12 deficiency in a patient on metformin, and deprescribing of flecainide. Fewer patients reported pain by the end of the study. Clinicians worried about staff time.
The trial is small and measured process — problems addressed — rather than hard outcomes. But it shows that asking patients systematically about symptoms, rather than waiting for them to volunteer, turns up drug harms in repeat prescribing.
- Ask older patients on polypharmacy about specific symptoms: falls, dizziness, constipation, confusion, pain
- Link each symptom to a possible culprit drug at medication review
- Check B12 in long-term metformin users
- Review the indication for antiarrhythmics and other high-risk drugs at every review
Why it matters
Drug harms in repeat prescribing are often invisible until someone asks about them directly.
Don't overread it
With 57 patients and a process outcome, this trial cannot show fewer hospital admissions or deaths.
The statistics, in plain English
An odds ratio of 7.48 is large, but the interval (1.99 to 28.1) is very wide because only 57 patients completed the study. The true effect could be much smaller. The outcome was problems addressed, not fewer admissions or deaths.
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