# Assessing Older Adults' Adherence to Appropriate Polypharmacy: Selection of Outcome Measures for Intervention Trials

## TL;DR

This paper identifies four key tools to measure medication adherence and treatment burden in older adults taking multiple medications, aiming to improve clinical trial consistency.

## Contribution

The study uses consensus methods to select validated outcome measures for assessing polypharmacy adherence in older adults.

## Key findings

- Four OMIs reached consensus: ARMS, MTBQ, MRB-QoL, and a measure for adverse events.
- Consensus was not achieved for cost-effectiveness or healthcare utilization measures.
- Selected OMIs assess adherence, treatment burden, quality of life, and side effects.

## Abstract

Outcome measurement instruments (OMIs) are important for evaluating intervention effectiveness and quality. However, adopting OMIs remains challenging. This study aimed to select OMIs for a core outcome set (COS) for use in studies focusing on adherence to appropriate polypharmacy in older people.

A list of OMIs for COS outcomes and their feasibility information was compiled from the literature to select one OMI per outcome. Two rounds of Delphi questionnaires containing a range of OMIs were distributed to experts [academics, healthcare professionals (HCPs), journal editors and methodologists] who were asked to select OMIs for a subsequent consensus meeting using ‘Yes’, ‘No’, or ‘Uncertain’. The Delphi results were discussed and OMIs were voted on (Yes: important and No: unimportant) in a consensus meeting with experts and an interview with a public member. An OMI was included if ≥ 80% of participants voted on it as critical and ≤ 20% voted it as unimportant.

Twenty‐one OMIs were presented to experts (Round 1, n = 42; Round 2, n = 39) in the Delphi exercise to achieve consensus on nine OMIs. Following the consensus meeting and interview (experts, n = 5; public participants, n = 1), agreement was achieved to select four OMIs: the Adherence to Refills and Medications Scale (ARMS, 100%); Multimorbidity Treatment Burden Questionnaire (MTBQ, 100%); Medication‐Related Burden Quality of Life questionnaire (MRB‐QoL, 83.3%); and ‘the number of undesired consequences of the intervention that result from administering multiple medications in older people (83.3%)’ for measuring medication adherence across multiple medications (subjective); treatment burden; health‐related quality of life (HRQoL) and adverse events and side effects (AEs and SEs), respectively. No agreement was reached regarding cost‐effectiveness and healthcare utilization.

This study selected OMIs for use with a COS in studies to improve adherence to appropriate polypharmacy in older people. Future research should identify appropriate OMIs for the remaining outcomes.

Key points○Using consensus methodology, this study aimed to select outcome measurement instruments (OMIs) to be used in conjunction with a core outcome set for clinical trials aiming to improve adherence to appropriate polypharmacy.○Four OMIs were selected to assess medication adherence across multiple medications (subjective); treatment burden; health‐related quality of life; and adverse events and side effects.○Further research is required to identify suitable ways to measure other outcomes in the COS.
Why does this paper matter?○This paper outlines the selection of measurement instruments for a COS for use in clinical trials aimed at improving adherence to appropriate polypharmacy in older people. Implementing this COS and its associated instruments should enhance transparency, harmonize research data, and facilitate evidence synthesis in systematic reviews in adherence to appropriate polypharmacy in older people.

Key points○Using consensus methodology, this study aimed to select outcome measurement instruments (OMIs) to be used in conjunction with a core outcome set for clinical trials aiming to improve adherence to appropriate polypharmacy.○Four OMIs were selected to assess medication adherence across multiple medications (subjective); treatment burden; health‐related quality of life; and adverse events and side effects.○Further research is required to identify suitable ways to measure other outcomes in the COS.

Using consensus methodology, this study aimed to select outcome measurement instruments (OMIs) to be used in conjunction with a core outcome set for clinical trials aiming to improve adherence to appropriate polypharmacy.

Four OMIs were selected to assess medication adherence across multiple medications (subjective); treatment burden; health‐related quality of life; and adverse events and side effects.

Further research is required to identify suitable ways to measure other outcomes in the COS.

Why does this paper matter?○This paper outlines the selection of measurement instruments for a COS for use in clinical trials aimed at improving adherence to appropriate polypharmacy in older people. Implementing this COS and its associated instruments should enhance transparency, harmonize research data, and facilitate evidence synthesis in systematic reviews in adherence to appropriate polypharmacy in older people.

This paper outlines the selection of measurement instruments for a COS for use in clinical trials aimed at improving adherence to appropriate polypharmacy in older people. Implementing this COS and its associated instruments should enhance transparency, harmonize research data, and facilitate evidence synthesis in systematic reviews in adherence to appropriate polypharmacy in older people.