Conectar
Drug-related problems (DRPs) associated with oral anticancer drugs are frequent and require a new healthcare organisation to manage them on an outpatient basis. The aim of this article is to present the study protocol of the Drug Related problems in Oncology Practice (DROP) randomised controlled trial (RCT), endorsed by the French Society for Oncology Pharmacy. The main objective of the DROP RCT is to measure the impact at 6 months of the DROP community/hospital pharmaceutical intervention programme, compared with usual treatment, on the mean number of DRP (ie, adverse effects, drug–drug interactions, medication errors) related to oral anticancer drugs in at-risk outpatients.
The DROP protocol is a prospective, multicentre controlled clinical trial, with individual randomisation, comparing in parallel and in open, two groups of outpatients treated with oral anticancer drugs. The interventional group benefits from the DROP multidisciplinary intervention on oral anticancer treatment. The control group receives usual care. The primary outcome of the DROP RCT is the number of DRP due to oral anticancer drugs, per patient, identified between the inclusion of the patient and 6 months after inclusion
Approval to conduct this study was obtained for all participating centres from an Ethics Committee (Comité de Protection des Personnes Sud-Méditerranée V) in August 2018 in accordance with French law. The trial results will be disseminated at clinical conferences and published in peer-reviewed journals.
ClinicalTrials.gov: NCT03257969, recruitment started in June 2019. The current protocol version is V.9, 13 December 2023.
Background
Population aging has increased the need for solutions that help older adults live independently in their own homes, where medication management is a major challenge.
Objectives
In this systematic review, we assessed the effects of medication dispensers among home-dwelling older adults on outcomes within the five domains of the Quintuple Aim framework: user experiences, health and well-being outcomes, health service utilization and costs, care professional experiences, and equity.
Methods
We identified relevant studies by searching databases (Scopus, CENTRAL, PubMed, Web of Science, CINAHL, PsycINFO, and Cochrane Reviews) from January 2017 to April 2022 with a predefined search strategy and two-person abstract and full-text screening. Two authors extracted the most relevant data and assessed quality for each included study. We assessed the evidence using a four-level quality rating measure: strong, moderate, limited, or no evidence.
Results
We included five original studies and three systematic reviews, which provided information on 20 additional original studies. Data were extracted from these 25 original studies. We found significant results in 16 of them, mostly pointing to the beneficial effects of dispenser devices. Significant results for health and well-being outcomes were found in 13 out of 21 studies in which these were assessed, for service utilization in two out of five studies, for costs in two out of three studies, and for patient/carer experiences in one out of five studies. No study evaluated professional experiences or equity outcomes. Overall, strong evidence of a beneficial effect of dispenser devices in any outcome is lacking, but they can improve health outcomes (moderate evidence of beneficial effects of using dispenser devices on systolic and diastolic blood pressure, and hemoglobin A1c levels). For other outcome domains, there is no or only limited evidence for beneficial effects of dispenser devices.
Discussion
We found that the use of dispenser devices by home-dwelling older adults can improve clinical health outcomes and may reduce health service utilization and costs. More high-quality research is needed to get a better insight into their effects on service utilization and costs. Future studies should also examine the effects on care professionals’ experiences and equity. 
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