Journal of the American Geriatrics Society · 2026
Comparing In-Person Versus Self-Paced Polypharmacy Education in Older Adults: A Pragmatic Comparison of Delivery Format Effectiveness.
СтатьяСравнительное исследованиеPragmatic Clinical TrialПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Zimmerman Caleb, Haddad Christya, Himmel Katherine, Thomas Grace, Macdonald Lewis, Smith Tyler, Dalman Dean, Fakhoury Patrick, Pandey Jyotsna
Аннотация
BACKGROUND: Polypharmacy affects nearly 50% of older adults, increasing risks of adverse drug events, falls, and hospitalizations. While patient-centered educational interventions show promise, optimal delivery formats remain unclear.
METHODS: This pragmatic quasi-experimental study was conducted May to September 2025 in Michigan using venue-based allocation. Participants received identical educational content through either in-person presentation (n = 60) or self-paced packet with pamphlet, video, and multimedia formats (n = 80). Educational components included the World Health Organization Five Moments for Medication Safety framework and a study-developed drug list collection tool. The primary outcome was medication management confidence (5-point Likert scale). Secondary outcomes included polypharmacy knowledge, self-efficacy, and tool adoption intentions. Paired t-tests assessed pre-post changes, and analysis of covariance compared formats adjusting for age, sex, race, thyroid disorder, arthritis, and baseline confidence.
RESULTS: The sample (N = 140, mean age 70.0 ± 12.0 years, 57.1% female, 82.1% White) showed significant improvement in medication management confidence (mean change = 0.24 points, 95% CI: 0.12 to 0.36, p < 0.001, d = 0.33). Both formats demonstrated significant within-group improvements (in-person: 0.32 points, p = 0.005; self-paced: 0.19 points, p = 0.010). After covariate adjustment, no significant difference existed between formats (adjusted difference: 0.01 points, p = 0.911). Knowledge of polypharmacy definition improved from 82.9% to 97.1%. Post hoc power analysis indicated the study was powered to detect moderate between-format differences (d ≥ 0.48); the observed between-format effect (d = 0.18) was smaller, suggesting any true difference is likely small rather than moderate or large.
CONCLUSIONS: Both formats produced significant improvements in medication management confidence and knowledge, with no significant difference between delivery formats after adjustment. These findings support flexible implementation strategies, allowing delivery approaches based on resource availability, patient needs, and setting with potential for scalable dissemination to populations facing transportation, scheduling, or mobility barriers.
METHODS: This pragmatic quasi-experimental study was conducted May to September 2025 in Michigan using venue-based allocation. Participants received identical educational content through either in-person presentation (n = 60) or self-paced packet with pamphlet, video, and multimedia formats (n = 80). Educational components included the World Health Organization Five Moments for Medication Safety framework and a study-developed drug list collection tool. The primary outcome was medication management confidence (5-point Likert scale). Secondary outcomes included polypharmacy knowledge, self-efficacy, and tool adoption intentions. Paired t-tests assessed pre-post changes, and analysis of covariance compared formats adjusting for age, sex, race, thyroid disorder, arthritis, and baseline confidence.
RESULTS: The sample (N = 140, mean age 70.0 ± 12.0 years, 57.1% female, 82.1% White) showed significant improvement in medication management confidence (mean change = 0.24 points, 95% CI: 0.12 to 0.36, p < 0.001, d = 0.33). Both formats demonstrated significant within-group improvements (in-person: 0.32 points, p = 0.005; self-paced: 0.19 points, p = 0.010). After covariate adjustment, no significant difference existed between formats (adjusted difference: 0.01 points, p = 0.911). Knowledge of polypharmacy definition improved from 82.9% to 97.1%. Post hoc power analysis indicated the study was powered to detect moderate between-format differences (d ≥ 0.48); the observed between-format effect (d = 0.18) was smaller, suggesting any true difference is likely small rather than moderate or large.
CONCLUSIONS: Both formats produced significant improvements in medication management confidence and knowledge, with no significant difference between delivery formats after adjustment. These findings support flexible implementation strategies, allowing delivery approaches based on resource availability, patient needs, and setting with potential for scalable dissemination to populations facing transportation, scheduling, or mobility barriers.