Multi-morbidityTAPER-RCTNCT02942927
Team Approach to Polypharmacy Evaluation and Reduction
A study testing Medication reduction in people with Multi-morbidity and Medication Therapy Management, run by McMaster University at 1 site in Canada.
Trial summary
In an aging population, most seniors suffer from multiple chronic conditions. When the number of medications taken is ≥5 (polypharmacy), the burden of taking multiple concurrent medications can do more harm than good. Read more about this study
- Who is it for?
- Ages 70 years and older
- Conditions the study is for
- Multi-morbidity, Medication Therapy Management, Polypharmacy
- What is being tested?
- Medication reduction
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 345 participants
- Where
- 1 siteCanada
- Study dates
- 4 Jun 2018to 31 Jul 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 70 years and older
- All sexes
- No healthy volunteers
- Older adult
Who may be able to join
- Aged 70 years of age or older
- Patient must have a family doctor
- Participating family doctor as most responsible provider
- Currently taking more 5 or more long-term medications
- Have not had a recent (past 12 months) comprehensive medication review
- Patient willing to try discontinuation
Who cannot join
- English language or cognitive skills inadequate to understand and respond to rating scales
- Terminal illness or other circumstance precluding 6 month study period
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Team Approach to Polypharmacy Evaluation and Reduction Randomized Controlled Trial
In an aging population, most seniors suffer from multiple chronic conditions. When the number of medications taken is ≥5 (polypharmacy), the burden of taking multiple concurrent medications can do more harm than good. Seniors take an average of 7 regular medications and studies link polypharmacy with adverse effects on morbidity, function and health service use. However, it is not clear to what extent these are reversible if medication burden is reduced.
This trial will test the effects on medication numbers and patient health outcomes of an intervention to polypharmacy. This study will test a program focused on medication reduction number and dose. Prioritizing medications according to the patient's preference as reducing the dose also reduces the risk of drug side effects.
Read more
Patients, aged 70 years of age or older and are taking ≥5 medications, will randomly receive the program immediately or at 6 months. The program involves information gathering from the patient, including systematically seeking patients priorities and preferences medication review with the pharmacist and then a consultation with the family doctor. The intervention is focused on discontinuing/reducing the dose of medications where possible using a 'pause and monitor' framework to assess the need for restart. An electronic program that detects drug adverse effects and flags potentially inappropriate medications will be integrated into an electronic clinical pathway incorporating monitoring and follow up systems.
This study will examine effects on patient and health relevant outcome measures as well as qualitative research exploring patients' and clinicians' experiences of reducing medication burden. The results will be used to determine whether this system can be implemented as part of routine preventative care in primary care for older adults.
Read the detailed description
Patients will be randomized 1:1 to receive the intervention at study start or delayed appointment 6 months later. Initial baseline data collection from the patient include data on demographics, medications, and illness characteristics. The patient will then attend an appointment with a pharmacist to review medications appropriate for discontinuation/dose reduction, after which the patient will meet with their family physician to discuss patient preferences for discontinuation/dose reduction. Both health care providers will have access to TaperMD, a web based program linked to evidence and tools to support reduction in polypharmacy. Follow-up research assessments will take place at one week, 3 months and 6 months (study end). Outcome assessments and a semi-structured interview will take place at the 6 month appointment.
- Conditions
- Multi-morbidity, Medication Therapy Management, Polypharmacy
- Being tested
- Medication reduction
- Keywords
- Polypharmacy, Multimorbidity, Randomized Control Trial, Drug Discontinuation, Patient Preference, eHealth
- Medical subject headings
- Patient Preference
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Medication reductionOther
Also called Medication discontinuation/dose reduction
Systematic approach to reduction in polypharmacy.
| Study group | Role | What they receive |
|---|---|---|
| TAPER | Experimental | The intervention is medication reduction. This arm is comprised of:
1. Medication reconciliation
2. Identification of patient priorities for care
3. Identification of medications that are potentially appropriate for discontinuation/dose reduction
4. Linked pharmacist/family physician consultations with patient to discuss medication with intention to reduce
5. Identification of medications for trial of discontinuation/dose reduction (shared decision making)
6. Pause of medication and clinical monitoring Receives: Other: Medication reduction |
| Control | No intervention | Standard of Care as wait list control. Control group will be offered intervention as part of usual clinical care at 6 months. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Successful discontinuation (mean difference in number of medications)
Difference in mean number of medications
Measured: Baseline, 6 months
Secondary outcomes (24)
Quality of life (EQ5D-5L)
EuroQol five dimensions questionnaire (EQ5D-5L)
Measured: Baseline, 6 months
Quality of life (SF36v2)
The Short Form (36) Health Survey (SF-36-V2)
Measured: Baseline, 6 months
Cognition
The Mini Mental Status Examination (MMSE)
Measured: Baseline, 6 months
Fatigue
Avlund Mob-T Scale
Measured: Baseline, 6 months
Patient experience of pain
Brief Pain Inventory (Pain interference and Pain severity sub-scales)
Measured: Baseline, 6 months
Patient enablement
The Patient Enablement Index (PEI)
Measured: Baseline, 6 months
Sleep
15-D Scale (Sleep Question)
Measured: Baseline, 6 months
Disease burden
Disease Burden Survey (Bayliss et al., 2009)
Measured: Baseline, 6 months
Nutritional status
Mini Nutritional Assessment Short-Form (MNA-SF)
Measured: Baseline, 6 months
Treatment burden
Brief Treatment Burden Scale
Measured: Baseline, 6 months
Falls
Total number of falls resulting in medication consultation or treatment recorded in hospital admission and primary care records, and by patient
Measured: Baseline, 6 months
Physical functional capacity and ability
Manty structured validated interview
Measured: Baseline, 6 months
Physical function capacity and ability (timed-up-and-go)
Timed up and go test (TUG)
Measured: Baseline, 6 months
Physical function capacity and ability (strength)
Grip strength
Measured: Baseline, 6 month
Physical function capacity and ability (balance)
Global Rating of Change (Balance)
Measured: Baseline, 6 months
Healthcare resource utilization (hospital admissions)
Number of hospital admissions from administrative data and self-report; proportion of patients with at least one hospitalization
Measured: Baseline, 6 months
Healthcare resource utilization (ED/urgent care visits)
Number of emergency department and urgent care visits from administrative data and self-report
Measured: Baseline, 6 months
Healthcare resource utilization (primary care visits)
Number of primary care visits from administrative data
Measured: baseline, 6 months
Successful discontinuation or dose reduction
Composite variable calculate to represent mean number of medications stopped or dose reductions
Measured: 6 months
Successful discontinuation or dose reduction (proportion)
Proportion of patients with successful discontinuations or dose reductions
Measured: 6 months
Changes in medication side effects and symptoms (adverse)
Patient self-report of appearance (new or worsening) of side effects associated with medications
Measured: 1 week, 3 month, 6 month
Changes in medication side effects and symptoms (positive)
Patient self-report of disappearance (improvement or disappearance) of side effects associated with medications
Measured: 1 week, 3 month, 6 month
Serious adverse events
Any event that requires in-patient hospitalization or prolongation of existing hospitalization, causes congenital malformation, results in persistent or significant disability or incapacity, is life-threatening or results in death (Health Canada (2011) Guidance Document for Industry - Reporting Adverse Reactions to Marketed Health Products)
Measured: 3 months, 6 months
Medication self-efficacy
Self-efficacy for appropriate mediation use scale
Measured: Baseline, 6 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted24 Oct 2016 (estimated)
- Study start4 Jun 2018
- Primary completion31 Jul 2025
- Study completion31 Jul 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Multi-morbidityStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind
- Who is masked
- Investigator, Outcomes assessor
- Enrolment
- 345 participants (actual)
Sponsor and investigators
- Lead sponsor
- McMaster University
- Sponsor type
- University, hospital or other
- Collaborators
- Canadian Institutes of Health Research (CIHR), David Braley and Nancy Gordon Chair in Family Medicine, RxISK
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02942927
- Sponsor's protocol ID
- RN293982 - 367123
- Acronym
- TAPER-RCT
- Status last verified
- Oct 2023
- First submitted
- 22 Aug 2016
- Last updated
- 12 Jan 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Undecided
Publications
Mangin D, Lamarche L, Agarwal G, Banh HL, Dore Brown N, Cassels A, Colwill K, Dolovich L, Farrell B, Garrison S, Gillett J, Griffith LE, Holbrook A, Jurcic-Vrataric J, McCormack J, O'Reilly D, Raina P, Richardson J, Risdon C, Savelli M, Sherifali D, Siu H, Tarride JE, Trimble J, Ali A, Freeman K, Langevin J, Parascandalo J, Templeton JA, Dragos S, Borhan S, Thabane L. Team approach to polypharmacy evaluation and reduction: study protocol for a randomized controlled trial. Trials. 2021 Oct 26;22(1):746. doi: 10.1186/s13063-021-05685-9.
PubMed 34702336
Study at a glance
From the registry record, last updated by the sponsor on 12 Jan 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Team Approach to Polypharmacy Evaluation and Reduction Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT02942927
- Acronym / sponsor ID
- TAPER-RCT / RN293982 - 367123
- Conditions
- Multi-morbidity, Medication Therapy Management, Polypharmacy
- Keywords
- Polypharmacy, Multimorbidity, Randomized Control Trial, Drug Discontinuation, Patient Preference, eHealth
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 345 participants (actual)
- Lead sponsor
- McMaster UniversityUniversity, hospital or other
- Collaborators
- Canadian Institutes of Health Research (CIHR), David Braley and Nancy Gordon Chair in Family Medicine, RxISK
- Study start
- 4 Jun 2018 (actual)
- Primary completion
- 31 Jul 2025 (actual)
- Study completion
- 31 Jul 2025 (actual)
- First posted
- 24 Oct 2016 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
In an aging population, most seniors suffer from multiple chronic conditions. When the number of medications taken is ≥5 (polypharmacy), the burden of taking multiple concurrent medications can do more harm than good. Seniors take an average of 7 regular medications and studies link polypharmacy with adverse effects on morbidity, function and health service use. However, it is not clear to what extent these are reversible if medication burden is reduced.
This trial will test the effects on medication numbers and patient health outcomes of an intervention to polypharmacy. This study will test a program focused on medication reduction number and dose. Prioritizing medications according to the patient's preference as reducing the dose also reduces the risk of drug side effects.
Patients, aged 70 years of age or older and are taking ≥5 medications, will randomly receive the program immediately or at 6 months. The program involves information gathering from the patient, including systematically seeking patients priorities and preferences medication review with the pharmacist and then a consultation with the family doctor. The intervention is focused on discontinuing/reducing the dose of medications where possible using a 'pause and monitor' framework to assess the need for restart. An electronic program that detects drug adverse effects and flags potentially inappropriate medications will be integrated into an electronic clinical pathway incorporating monitoring and follow up systems.
This study will examine effects on patient and health relevant outcome measures as well as qualitative research exploring patients' and clinicians' experiences of reducing medication burden. The results will be used to determine whether this system can be implemented as part of routine preventative care in primary care for older adults.
Detailed description
Patients will be randomized 1:1 to receive the intervention at study start or delayed appointment 6 months later. Initial baseline data collection from the patient include data on demographics, medications, and illness characteristics. The patient will then attend an appointment with a pharmacist to review medications appropriate for discontinuation/dose reduction, after which the patient will meet with their family physician to discuss patient preferences for discontinuation/dose reduction. Both health care providers will have access to TaperMD, a web based program linked to evidence and tools to support reduction in polypharmacy. Follow-up research assessments will take place at one week, 3 months and 6 months (study end). Outcome assessments and a semi-structured interview will take place at the 6 month appointment.
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| TAPER | Experimental | Other: Medication reductionThe intervention is medication reduction. This arm is comprised of: 1. Medication reconciliation 2. Identification of patient priorities for care 3. Identification of medications that are potentially appropriate for discontinuation/dose reduction 4. Linked pharmacist/family physician consultations with patient to discuss medication with intention to reduce 5. Identification of medications for trial of discontinuation/dose reduction (shared decision making) 6. Pause of medication and clinical monitoring |
| Control | No intervention | –Standard of Care as wait list control. Control group will be offered intervention as part of usual clinical care at 6 months. |
Who may qualify
- Ages
- 70 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Older adult
Key inclusion criteria (6 listed)
- Aged 70 years of age or older
- Patient must have a family doctor
- Participating family doctor as most responsible provider
- Currently taking more 5 or more long-term medications
- Have not had a recent (past 12 months) comprehensive medication review
Key exclusion criteria (2 listed)
- English language or cognitive skills inadequate to understand and respond to rating scales
- Terminal illness or other circumstance precluding 6 month study period
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Medication reductionAlso: Medication discontinuation/dose reductionSystematic approach to reduction in polypharmacy. | Other | TAPER |
Primary outcome
Successful discontinuation (mean difference in number of medications)
Time frame: Baseline, 6 months
Difference in mean number of medications
24 secondary outcomes
Quality of life (EQ5D-5L)
Time frame: Baseline, 6 months
Quality of life (SF36v2)
Time frame: Baseline, 6 months
Cognition
Time frame: Baseline, 6 months
Fatigue
Time frame: Baseline, 6 months
Patient experience of pain
Time frame: Baseline, 6 months
Patient enablement
Time frame: Baseline, 6 months
Sleep
Time frame: Baseline, 6 months
Disease burden
Time frame: Baseline, 6 months
Nutritional status
Time frame: Baseline, 6 months
Treatment burden
Time frame: Baseline, 6 months
Falls
Time frame: Baseline, 6 months
Physical functional capacity and ability
Time frame: Baseline, 6 months
Physical function capacity and ability (timed-up-and-go)
Time frame: Baseline, 6 months
Physical function capacity and ability (strength)
Time frame: Baseline, 6 month
Physical function capacity and ability (balance)
Time frame: Baseline, 6 months
Healthcare resource utilization (hospital admissions)
Time frame: Baseline, 6 months
Healthcare resource utilization (ED/urgent care visits)
Time frame: Baseline, 6 months
Healthcare resource utilization (primary care visits)
Time frame: baseline, 6 months
Successful discontinuation or dose reduction
Time frame: 6 months
Successful discontinuation or dose reduction (proportion)
Time frame: 6 months
Changes in medication side effects and symptoms (adverse)
Time frame: 1 week, 3 month, 6 month
Changes in medication side effects and symptoms (positive)
Time frame: 1 week, 3 month, 6 month
Serious adverse events
Time frame: 3 months, 6 months
Medication self-efficacy
Time frame: Baseline, 6 months
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 12 Jan 2026.
- Derived from this study: PubMed 34702336Mangin D, Lamarche L, Agarwal G, Banh HL, Dore Brown N, Cassels A, Colwill K, Dolovich L, Farrell B, Garrison S, Gillett J, Griffith LE, Holbrook A, Jurcic-Vrataric J, McCormack J, O'Reilly D, Raina P, Richardson J, Risdon C, Savelli M, Sherifali D, Siu H, Tarride JE, Trimble J, Ali A, Freeman K, Langevin J, Parascandalo J, Templeton JA, Dragos S, Borhan S, Thabane L. Team approach to polypharmacy evaluation and reduction: study protocol for a randomized controlled trial. Trials. 2021 Oct 26;22(1):746. doi: 10.1186/s13063-021-05685-9.
- Individual participant dataSharing planned: Undecided
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Medication reduction in people with Multi-morbidity and Medication Therapy Management, run by McMaster University at 1 site in Canada.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 6 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 12 Jan 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Successful discontinuation (mean difference in number of medications) (time frame: Baseline, 6 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT02942927, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Jan 2026.