Deprescribing in older patients with hyperpolypharmacy: a cluster-randomised trial in primary care

Age and Ageing, vol. 55

Abstract

BACKGROUND: Polypharmacy increases the risk of adverse drug events and potentially preventable hospital admissions. Deprescribing may reduce medication-related harm, and a clinical medication review (CMR) provides an opportunity to support this. OBJECTIVE: To investigate the effect of a deprescribing-focused CMR by trained pharmacists on the number of reduced and stopped medications among patients aged ≥75 years with hyperpolypharmacy using multidose-drug-dispensing (MDD)-systems. METHODS: In this cluster-randomised controlled trial, pharmacists were trained to perform a deprescribing-focused CMR, while control pharmacies provided usual care. Eligible patients were aged ≥75 years, had hyperpolypharmacy and used MDD. Dispensing data were used to determine the number of reduced and stopped medications per patient after 6 months (primary outcome). Secondary outcomes were: total number of medications, health problems and quality-of-life (EQ-5D-5L, EQ-VAS). A generalised linear mixed model was used for the primary outcome. RESULTS: A total of 318 patients from 58 pharmacies were enrolled (155 intervention, 163 control). At 6 months, patients in the intervention group had significantly more medications deprescribed than those in the control group (mean 2.5 vs. 1.7 per patient; mean difference 0.79, 95% CI 0.29-1.28; P = .002). There was no significant between-group difference in the total number of medications at 6 months (intervention -0.30 vs. control +0.12; P = .108). No significant differences were observed in health problems or quality-of-life. CONCLUSION: Deprescribing-focused CMRs by trained pharmacists successfully increased reduction and stopping of medications in older patients with hyperpolypharmacy using MDD-systems, while no changes in health problems or health-related quality of life could be observed over 6 months.

Authors 9

1. Gert Baas corresponding Aachen SIR Institute for Pharmacy Practice and Policy

   Utrecht University · SIR Institute for Pharmacy Practice and Policy

   Affiliation as printed

   Department of Pharmaceutical Sciences, Utrecht University , Utrecht 125 ,

   SIR Institute for Pharmacy Practice and Policy , Leiden, ZH ,

2. Mette Heringa Aachen SIR Institute for Pharmacy Practice and Policy

   SIR Institute for Pharmacy Practice and Policy

   Affiliation as printed

   SIR Institute for Pharmacy Practice and Policy , Leiden, ZH ,

3. Sanne Verdoorn Aachen SIR Institute for Pharmacy Practice and Policy

   SIR Institute for Pharmacy Practice and Policy

   Affiliation as printed

   SIR Institute for Pharmacy Practice and Policy , Leiden, ZH ,

4. Henk‐Frans Kwint Aachen SIR Institute for Pharmacy Practice and Policy

   SIR Institute for Pharmacy Practice and Policy

   Affiliation as printed

   SIR Institute for Pharmacy Practice and Policy , Leiden, ZH ,

5. Eman Badawy Aachen SIR Institute for Pharmacy Practice and Policy

   SIR Institute for Pharmacy Practice and Policy

   Affiliation as printed

   SIR Institute for Pharmacy Practice and Policy , Leiden, ZH ,

6. Jacobijn Gussekloo Aachen Public Health and Primary Care

   Leiden University Medical Center

   Affiliation as printed

   Public Health and Primary Care, Leiden University Medical Center , Leiden ,

7. Jako S. Burgers

   Maastricht University · Dutch College of General Practitioners

   Affiliation as printed

   Department of Family Medicine, Maastricht University , Maastricht, LI ,

   Dutch College of General Practitioners (NHG) , Utrecht ,

8. Petra Denig

   University Medical Center Groningen · University of Groningen

   Affiliation as printed

   Clinical Pharmacy & Pharmacology, University of Groningen, University Medical Center Groningen , PO Box 30001 EB71, Groningen 9700RB ,

9. Marcel L. Bouvy

   Utrecht University

   Affiliation as printed

   Department of Pharmaceutical Sciences, Utrecht University , Utrecht 125 ,