A Swiss Interprofessional Network for Reviewing Inappropriate Medication in Primary Care (SINERGIC)

A Swiss Interprofessional Network for Reviewing Inappropriate Medication in Primary Care: a Pilot Study

The aim of the SINERGIC pilot study is to assess the feasibility in the Swiss context of implementing interprofessional medication reviews between GP and pharmacists, as part of a shared decision-making process with patients. The acceptability and potential effectiveness of such an intervention will also be assessed.

This assessment will enable the investigators to take into account the determining factors for setting up a large-scale study to support the sustainable financing of this service in the long term.

Study Overview

• Status: Enrolling by invitation
• Conditions: Primary Care; Medication Review
• Intervention / Treatment: Other: Medication review

Detailed Description

The ageing population is leading to an increase in the prevalence of chronic conditions among older adults, often resulting in excessive polypharmacy. Polypharmacy, as well as the prescription of high-risk medications in this population, exposes them to more adverse effects, which can lead to falls and hospitalisation. This problem is of concern to healthcare professionals, whether they be general practitioners (GP), who have an overview of medical records, or dispensing pharmacists, who have an overview of medication. In Switzerland, these two professions still operate often in isolation from each other, but genuine collaboration is essential if we are to improve and manage polypharmacy among the elderly and limit the risks. Medication reviews are recognised as promising strategies for improving the quality of prescribing in patients with multiple medications.

This pilot trial does not randomly select participants and does not include a control group. It is a hybrid study that aims both to test the effectiveness of the intervention and to prepare for its implementation.

The study plans to include at least 250 patients from three groups of general practices in different settings. Participants will be aged 65 or older, take at least five chronic medications, and suffer from at least three chronic conditions. Individuals living in medical institutions will not be included.

Intervention:

• Step 1 (optional): Patients taking at least 10 chronic medications and experiencing adherence or side effect issues may benefit from a specialised consultation with a pharmacist.
• Step 2: The pharmacist identifies any medication-related issues for each patient and discusses them directly with the general practitioner in order to agree on the necessary adjustments.
• Step 3: During a medical appointment, the doctor and patient will decide together whether to implement the proposed changes.
• Step 4: The pharmacist will follow up after a few days and then again after 3 months.

Main objective: To assess whether this service is feasible in the context of the study.

Secondary objectives: Measure whether the intervention is well accepted (questionnaires and interviews) by the patients and healthcare professionals involved.

Exploratory objectives: Study the impact of the intervention on the quality of drug treatments, patients' quality of life and drug costs.

• Study Type: Interventional
• Enrollment (Estimated): 250
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Switzerland
  • Bern, Switzerland
    • Institute of Primary Health Care (BIHAM)

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Age ≥ 65 years old;
• Regular use of at least 5 medications (chronic treatments, > 3 months);
• Patients with a minimum of 3 chronic diseases;
• Regular follow-up in a GP practice taking part in the project;
• Adequate understanding of French.
• Written informed consent

Exclusion Criteria:

• Residence in an institution (residential care facility, nursing home, etc.) ;
• Cognitive impairment preventing understanding or obtaining informed consent;
• Any other clinical situation deemed incompatible with participation, as decided by the GP in charge.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Other: Patient with medication review

Other: Medication review; Step 1 (optional): Patients taking at least 10 chronic medications and experiencing adherence or side effect issues may benefit from a specialised consultation with a pharmacist.; Step 2: The pharmacist identifies any medication-related issues for each patient and discusses them directly with the general practitioner in order to agree on the necessary adjustments.; Step 3: During a medical appointment, the doctor and patient will decide together whether to implement the proposed changes.; Step 4: The pharmacist will follow up after a few days and then again after 3 months.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of participants recruited and percentage of participants retained	To assess the ability to recruit patients and retain patients for the duration of the follow-up and, if necessary, to explore the causes leading to their exit from the study; Measure: percentage	End of the study, expected to be on average after 4-6 months
Number of GPs recruited and percentage of GPs retained	To assess the ability to recruit patients and retain patients for the duration of the follow-up and, if necessary, to explore the causes leading to their exit from the study; Measure: percentage	End of the study, expected to be on average after 18 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cost of the service	Median cost of the intervention (in CHF) is calculated as the time invested by healthcare professionals (GPs, pharmacists) to conduct it multiplied by their average hourly wage.	During interprofessional meeting between GP and pharmacist
Score of participants' acceptability of the intervention (Patients Reported Experience Measures)	Patients' acceptability of the service is assessed using a questionnaire adapted from the Short Assessment of Patient Satisfaction (SAPS). This is a short, 6 to 7-item scale used to assess patients' perceptions of the effectiveness of their treatments, and can help identify ways of improving a practice or intervention and responding to patients' concerns. Scale from 1 to 5, with higher values representing higher acceptance	End of the study, expected to be on average after 4-6 months
Score of the healthcare professionals' acceptability of the intervention	GPs' acceptability of the service is assessed using an online questionnaire inspired by the Collaboration and Satisfaction About Care Decisions (CSACD) questionnaire and the Assessment of Interprofessional Team Collaboration Scale (AITCS-II). A 6-items scale from 1 to 5, with higher values representing higher acceptance Additional semi-structured interviews based on a convenience sample will be conducted with health care professionals taking part to the main study by a trained student, in order to explore the conditions for implementing this new service in ambulatory care.	End of the study, up to 18 months
Qualitative evaluation of healthcare professionals' acceptability	Semi-structured interviews based on a convenience sample will be conducted with health care professionals taking part to the main study by a trained student, in order to explore the conditions for implementing this new service in ambulatory care. Free text, qualitative analysis	End of the study, up to 18 months
Number and percentage of clinically relevant drug related problems resolved	The quality of medication therapy is assessed using a composite criterion based on five types of clinically relevant DRPs, taken from the recommendations of Beuscart et al. These DRPs will be documented using the validated PharmDisc tool adapted to our context. These DRPs reflect the appropriateness of prescribing. Their high frequency reflects poor prescribing quality. In order to standardise their identification, clinical pharmacists will be trained and using a protocol. PIMs will be identified according to the EU(7)-PIM list, which is a Europe-wide list.	3 months after medical consultation
Amount of drug cost savings	Savings in drug costs (in CHF) calculated for medications that were modified following the medication review and maintained three months later. The cost difference will be estimated using the change in drug daily dose multiplied by the public price per unit.	3 months after medical consultation
Score on health-related quality of life (Patient-Reported Outcomes Measures or PROMs)	PROMs will be collected using a questionnaire adapted from the iSIMPATHY project, incorporating the EQ-5D-5L. The questionnaire assesses several dimensions: mobility, usual activities, pain/discomfort, anxiety/depression, as well as the patient's priorities in relation to their medication. A convenience sample will be drawn up with a minimum of 10 patients per group of GP practices. A five-items scale from 1 to 3, with higher values representing worst clinical outcomes	3 months after medical consultation

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of DRPs identified	Number of DRPs identified comparatively to those identified by the expert panel. Measure : percentage	Evaluation of pharmacists clinical skills, End of the study, up to 18 months
Number and percentage of clinically relevant pharmaceutical interventions	Percentage of interventions clinically relevant evaluated by a panel of expert based on a standardised scale from 1 to 100, with higher values meaning best clinical relevance	Evaluation of pharmacists clinical skills, End of the study, up to 18 months

Collaborators and Investigators

• Sponsor: University of Bern
• Investigators: Study Chair: Camille Lanfranchi, MSc, University of Bern (BIHAM); Study Chair: Juliane Fringeli, MSc, University of Bern (BIHAM)

Publications and helpful links

General Publications

• Mallet L, Spinewine A, Huang A. The challenge of managing drug interactions in elderly people. Lancet. 2007 Jul 14;370(9582):185-191. doi: 10.1016/S0140-6736(07)61092-7.
• Liew TM, Lee CS, Goh SKL, Chang ZY. The prevalence and impact of potentially inappropriate prescribing among older persons in primary care settings: multilevel meta-analysis. Age Ageing. 2020 Jul 1;49(4):570-579. doi: 10.1093/ageing/afaa057.
• Cole JA, Goncalves-Bradley DC, Alqahtani M, Barry HE, Cadogan C, Rankin A, Patterson SM, Kerse N, Cardwell CR, Ryan C, Hughes C. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2023 Oct 11;10(10):CD008165. doi: 10.1002/14651858.CD008165.pub5.

Study record dates

Study Major Dates

• Study Start (Actual): February 2, 2026
• Primary Completion (Estimated): July 30, 2026
• Study Completion (Estimated): July 30, 2027

Study Registration Dates

• First Submitted: December 2, 2025
• First Submitted That Met QC Criteria: December 2, 2025
• First Posted (Actual): December 15, 2025

Study Record Updates

• Last Update Posted (Actual): February 13, 2026
• Last Update Submitted That Met QC Criteria: February 10, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Clinical pharmacist; Medication review; Pharmaceutical service; Interprofessionality
• Additional Relevant MeSH Terms: Organization and Administration; Health Services Administration; Patient Care Management; Medication Systems; Medication Review
• Other Study ID Numbers: SINERGIC_01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Once fully anonymized, quantitative data will be annotated and structured to make them sharable, and registered in a FAIR-compliant data repository.
• IPD Sharing Time Frame: Since now until 5 years after study completion
• IPD Sharing Access Criteria: on Demand (to main authors)
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No