Feasibility of implementing an intervention in general practice for deprescribing of glucose-lowering medication in overtreated elderly

Family Practice, vol. 42

Abstract

BACKGROUND: Elderly patients with Type 2 diabetes (T2D) are frequently overtreated with glucose-lowering medication. OBJECTIVE: This feasibility study evaluated the implementation of a deprescribing programme (DPP) for general practices, consisting of education, a patient selection tool, practice visits, and an expert support panel, before scaling it in a randomized controlled trial. METHODS: Quantitative evaluation included the number of patients with T2D eligible for deprescribing using medical records and study progress data. Qualitative evaluation entailed the analysis of minutes made during training, and interviews with health care providers (HCPs). The extended normalization process theory guided analysis. RESULTS: In 10 practices, 55 out of 65 eligible patients were deprescribed glucose-lowering medication, with 22 restarts. Most execution steps were perceived as the practice nurse's responsibility, whereas the general practitioner needed to approve the deprescribing. Practice nurses found the educational training, including peer-to-peer sessions and practice visits, supportive of integrating deprescribing into practice. DPP procedures and tasks not part of the regular care process were not consistently performed. The DPP was adapted to minimize study tasks for HCPs and align study procedures to existing routine procedures. CONCLUSION: Implementation of a DPP in general practice requires education, practice visits, and alignment of DPP components to regular care.

Authors 15

1. Charlotte Andriessen corresponding

   Amsterdam UMC Location University of Amsterdam · Amsterdam Public Health · Amsterdam University Medical Centers

   Affiliation as printed

   Amsterdam Public Health Research Institute , 1105 AZ Amsterdam ,

   Department of General Practice, Amsterdam University Medical Center , Meibergdreef 15, 1105 AZ Amsterdam ,

   Amsterdam Public Health Research Institute, 1105 AZ Amsterdam, The Netherlands

   Department of General Practice, Amsterdam University Medical Center, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands

2. Marieke Tabo Blom

   Amsterdam UMC Location University of Amsterdam · Amsterdam Public Health · Amsterdam University Medical Centers

   Affiliation as printed

   Amsterdam Public Health Research Institute , 1105 AZ Amsterdam ,

   Department of General Practice, Amsterdam University Medical Center , Meibergdreef 15, 1105 AZ Amsterdam ,

   Amsterdam Public Health Research Institute, 1105 AZ Amsterdam, The Netherlands

   Department of General Practice, Amsterdam University Medical Center, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands

3. Beryl A. C. E. van Hoek

   Amsterdam UMC Location University of Amsterdam · Amsterdam Public Health · Amsterdam University Medical Centers

   Affiliation as printed

   Amsterdam Public Health Research Institute , 1105 AZ Amsterdam ,

   Department of General Practice, Amsterdam University Medical Center , Meibergdreef 15, 1105 AZ Amsterdam ,

   Amsterdam Public Health Research Institute, 1105 AZ Amsterdam, The Netherlands

   Department of General Practice, Amsterdam University Medical Center, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands

4. Anna W de Boer Aachen Department of Public Health and Primary Care/Health Campus The Hague

   Leiden University Medical Center

   Affiliation as printed

   Department of Public Health and Primary Care/Health Campus The Hague, LUMC , 2333 ZD Leiden ,

   Department of Public Health and Primary Care/Health Campus The Hague, LUMC, 2333 ZD Leiden, The Netherlands

5. Petra Denig

   University Medical Center Groningen · University of Groningen

   Affiliation as printed

   Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen , 9700 AB Groningen ,

   Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, 9700 AB Groningen, The Netherlands

6. Ron M. C. Herings

   Pharmo Institute

   Affiliation as printed

   PHARMO Institute for Drug Outcomes Studies , 3528 AE Utrecht ,

   PHARMO Institute for Drug Outcomes Studies, 3528 AE Utrecht, The Netherlands

7. Angela de Rooij-Peek
   Affiliation as printed

   Diabetesvereniging Nederland , 3833 LD Leusden ,

   Diabetesvereniging Nederland, 3833 LD Leusden, The Netherlands

8. Rob J. van Marum

   Amsterdam University Medical Centers · Jeroen Bosch Ziekenhuis

   Affiliation as printed

   Department of Clinical Pharmacology, Jeroen Bosch Hospital , 5223 GZ ‘s-Hertogenbosch ,

   Department of Elderly Care Medicine, Amsterdam University Medical Center , 1081 HV Amsterdam ,

   Department of Geriatric Medicine, Jeroen Bosch Hospital , 5223 GZ ‘s-Hertogenbosch ,

   Department of Clinical Pharmacology, Jeroen Bosch Hospital, 5223 GZ 's-Hertogenbosch, The Netherlands

   Department of Elderly Care Medicine, Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands

   Department of Geriatric Medicine, Jeroen Bosch Hospital, 5223 GZ 's-Hertogenbosch, The Netherlands

9. Jacqueline Geertruida Hugtenburg

   Amsterdam University Medical Centers

   Affiliation as printed

   Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Center , 1081 HV Amsterdam ,

   Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands

10. Daniël H. van Raalte

    Amsterdam University Medical Centers

    Affiliation as printed

    Department of Internal Medicine, Diabetes Center, Amsterdam University Medical Center , 1081 HV Amsterdam ,

    Department of Internal Medicine, Diabetes Center, Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands

11. Liselotte van Bloemendaal

    Amsterdam University Medical Centers

    Affiliation as printed

    Department of Internal Medicine—Geriatrics, Amsterdam University Medical Center , 1081 HV Amsterdam ,

    Department of Internal Medicine-Geriatrics, Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands

12. Giel Nijpels

    Amsterdam UMC Location University of Amsterdam · Amsterdam Public Health · Amsterdam University Medical Centers

    Affiliation as printed

    Amsterdam Public Health Research Institute , 1105 AZ Amsterdam ,

    Department of General Practice, Amsterdam University Medical Center , Meibergdreef 15, 1105 AZ Amsterdam ,

    Amsterdam Public Health Research Institute, 1105 AZ Amsterdam, The Netherlands

    Department of General Practice, Amsterdam University Medical Center, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands

13. Marjan J. Westerman

    Amsterdam University Medical Centers

    Affiliation as printed

    Department of Epidemiology and Data Science, Amsterdam University Medical Center , 1105 AZ Amsterdam ,

    Department of Epidemiology and Data Science, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands

14. Rimke Cathelijne Vos Aachen Department of Public Health and Primary Care/Health Campus The Hague

    Leiden University Medical Center

    Affiliation as printed

    Department of Public Health and Primary Care/Health Campus The Hague, LUMC , 2333 ZD Leiden ,

    Department of Public Health and Primary Care/Health Campus The Hague, LUMC, 2333 ZD Leiden, The Netherlands

15. Petra J. M. Elders

    Amsterdam UMC Location University of Amsterdam · Amsterdam Public Health · Amsterdam University Medical Centers

    Affiliation as printed

    Amsterdam Public Health Research Institute , 1105 AZ Amsterdam ,

    Department of General Practice, Amsterdam University Medical Center , Meibergdreef 15, 1105 AZ Amsterdam ,

    Amsterdam Public Health Research Institute, 1105 AZ Amsterdam, The Netherlands

    Department of General Practice, Amsterdam University Medical Center, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands