Acceptability of patient-centered, multi-disciplinary medication therapy management recommendations: results from the INCREASE randomized study

Noah I. Smith, Ashley I. Martinez, Mark Huffmyer, Lynne Eckmann, Rosmy George, Erin L. Abner, Gregory A. Jicha, Daniela C. Moga

Research output: Contribution to journalArticlepeer-review


Background: Polypharmacy and inappropriate medications may be a modifiable risk factor for Alzheimer’s Disease and Related Dementias (ADRD). Medication therapy management (MTM) interventions may mitigate medication-induced cognitive dysfunction and delay onset of symptomatic impairment. The objective of the current study is to describe an MTM protocol for a patient-centered team intervention (pharmacist and non-pharmacist clinician) in a randomized controlled trial (RCT) directed at delaying the symptomatic onset of ADRD. Methods: Community dwelling adults 65 + years, non-demented, using ≥ 1 potentially inappropriate medications (PIM) were enrolled in an RCT to evaluate the effect of an MTM intervention on improving medication appropriateness and cognition (NCT02849639). The MTM intervention involved a three-step process: (1) pharmacist identified potential medication-related problems (MRPs) and made initial recommendations for prescribed and over-the-counter medications, vitamins, and supplements; (2) study team reviewed all initial recommendations together with the participants, allowing for revisions prior to the finalized recommendations; (3) participant responses to final recommendations were recorded. Here, we describe initial recommendations, changes during team engagement, and participant responses to final recommendations. Results: Among the 90 participants, a mean 6.7 ± 3.6 MRPs per participant were reported. Of the 259 initial MTM recommendations made for the treatment group participants (N = 46), 40% percent underwent revisions in the second step. Participants reported willingness to adopt 46% of final recommendations and expressed need for additional primary care input in response to 38% of final recommendations. Willingness to adopt final recommendations was highest when therapeutic switches were offered and/or with anticholinergic medications. Conclusion: The evaluation of modifications to MTM recommendations demonstrated that pharmacists’ initial MTM recommendations often changed following the participation in the multidisciplinary decision-making process that incorporated patient preferences. The team was encouraged to see a correlation between engaging patients and a positive overall response towards participant acceptance of final MTM recommendations. Trial registration: Study registration number: NCT02849639 registered on 29/07/2016.

Original languageEnglish
Article number137
JournalBMC Geriatrics
Issue number1
StatePublished - Dec 2023

Bibliographical note

Funding Information:
This study was supported by an unrestricted grant from the National Institutes of Health/National Institute on Aging (R01 AG054130). Additional support was provided by the University of Kentucky Center for Clinical and Translational Sciences (UL1TR000117).

Publisher Copyright:
© 2023, The Author(s).


  • Clinical trials
  • Deprescribing
  • Medication therapy management
  • Pharmacotherapy
  • Polypharmacy

ASJC Scopus subject areas

  • Geriatrics and Gerontology


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