Outcomes included in the Core Outcome Set (COS)
The Core Outcome Set (COS) for use in trials aimed at improving adherence to appropriate polypharmacy in older
alth--
1
A list of 13 Patient-Reported Outcome Measures (PROMs), five objective adherence measures and three
measurement methods were compiled from a previous study and different systematic reviews.
2-5
Information cards
were prepared and presented to experts in the Delphi consensus exercise (Table 1).
Table 1:
Outcome
Experts’ information cards for each outcome measurement
instruments
Medication adherence across
multiple medications
Suggested PROMs after the second round:
Treatment burden
Health-related quality of life
All adverse events and side effects
Healthcare utilisation
Cost-effectiveness
a
Figures representing the measurement instruments that met the inclusion threshold following the conclusion of the Delphi exercise
This list was voted on in a two-round Delphi questionnaire by academics, healthcare professionals, methodologists,
and journal editors (i.e. experts). After the second round, five PROMs and four measurement methods were
considered appropriate to be used in studies aimed at improving adherence to appropriate polypharmacy in older
patients.
This list included:
The Adherence to Refills and Medications Scale (ARMS), the Living with Medicines Questionnaire-3 (LMQ-3),
Multimorbidity Treatment Burden Questionnaire (MTBQ), the 5-level EQ-5D questionnaire (EQ-5D-5L), the
Medication-Related Burden Quality of Life (MRB-Qo
intervention (i.e. adverse events or side effects) that result from administering multiple medications in older
specified time period that results from
Selection of outcome measurement instruments for a core
outcome set for clinical trials targeting interventions
aiming to improve adherence to appropriate polypharmacy
in older people
questionnaire (Table 2).
Table 2:
measurement instrument following the end of the second Delphi questionnaire
Outcome
Public participants’ information cards for each outcome
measurement instruments
Medication adherence across
multiple medications
Treatment burden
Health-related quality of life
All adverse events and side effects
Healthcare utilisation
Cost-effectiveness
a
Figures showing the measurement instruments that met the threshold for inclusion after the expertsconsensus meeting and the
interview with the public member had concluded.
Please click on each outcome measurement instrument to see the information card (link to PDF)
The resultant list was presented and discussed in a consensus meeting with experts and another separate interview-
like meeting with one public member to select one measurement instrument for each outcome.
In the consensus meeting, only the MRB-
intervention (i.e. adverse events or side effects) that result from administering multiple medications in older
ion in the final list of measurement instruments.
References
1. Al Shaker H, Barry H, Hughes C. (2025) Development of a core outcome set for clinical trials targeting
interventions aiming to improve adherence to appropriate polypharmacy in older peoplean international
consensus study. Age and Ageing; 54(4): afaf102.
2. Cross AJ, Elliott RA, Petrie K, Kuruvilla L, George J. (2020) Interventions for improving medication-taking
ability and adherence in older adults prescribed multiple medications. Cochrane Database of Systematic Reviews;
5(5): CD012419.
3. Patton DE, Pearce CJ, Cartwright M, Smith F, Cadogan CA, Ryan C, Clark E, Francis JJ, Hughes CM. (2021) A non-
randomised pilot study of the Solutions for Medication Adherence Problems (S-MAP) intervention in community
pharmacies to support older adults adhere to multiple medications. Pilot and Feasibility Studies; 7(1): 18.
4. Mendoza-Quispe D, Perez-Leon S, Alarcon-Ruiz CA, Gaspar A, Cuba-Fuentes MS, Zunt JR, Montori VM, Bazo-
Alvarez JC, Miranda JJ. (2023) Scoping review of measures of treatment burden in patients with multimorbidity:
advancements and current gaps. Journal of Clinical Epidemiology; 159: 92-105.
5. Møller A, Bissenbakker KH, Arreskov AB, Brodersen J. (2020) Specific measures of quality of life in patients
with multimorbidity in primary healthcare: a systematic review on patient-
of measurement. Patient Related Outcome Measures; 11: 1-10.
