Systematic Medication Review in General Practice by an Interdisciplinary Team: A thorough but Laborious Method to Address Polypharmacy among Elderly Patients

Abstract

Polypharmacy increases the risk of hospitalization but may be reduced by medication review. The study objective is to describe and evaluate a method for conducting medication review in general practice by an interdisciplinary medication team of pharmacists and physicians—in this case conducted by a team from the Department of Clinical Pharmacology—based on information concerning medication, diagnosis, relevant laboratory data and medical history supplied by the general practitioner. We discussed the medication review with the patients’ general practitioners and received feedback from them regarding acceptance rates of the recommended changes. Ninety-four patients with a total of 1471 prescriptions were included. A medication change was recommended for nearly half of the prescriptions (48%); at least one change of medication was recommended for all patients. The acceptance rate for recommended medication changes was 55%, corresponding to a mean of 4.2 accepted recommendations per patient. For 18% of all 1471 prescriptions, the general practitioner agreed either to discontinue (stop the medication completely) or reduce the dose of the medication. This method is thorough, but since it requires several healthcare professionals, it is rather time-consuming. There is a need to support medication review in general practice, but although this method may be too time consuming in most cases, it may nevertheless prove to be a useful tool managing the most complicated patients.

Barriers and enablers to deprescribing in long-term care: A qualitative investigation into the opinions of healthcare professionals in Ireland

“…Despite best-practice guidelines, a US study documented limited PIM discontinuation rates, for older adults with limited life expectancy [ 26 ]. Similarly, deprescribing interventions, such as medication reviews, are considered unlikely to be incorporated into daily practice [ 27 ]. Researchers have called for an increased focus on implementation science to bridge the “research-to-practice gap”, which may increase deprescribing engagement in clinical practice by, for example, tailoring interventions to the long-term care environment [ 28 , 29 ].…”

Tailoring a complex intervention to reduce antidepressants in institutionalized older persons with dementia

“…This could be achieved in different ways, but it should include a clear understanding from both parts of what to expect when deprescribing and which symptoms the nursing home staff needed to be observant of as well as how to handle uncertainties. One of the experts, the clinical pharmacist with experience in deprescribing studies in Danish nursing homes, suggested using the Neuropsychiatric Inventory – nursing home version (NPI-NH) [ 26 , 51 ]. The symptom assessment scale was considered by both nursing home staff and GPs as a means to ensure a common language concerning what was relevant to report from nursing home staff to the GP.…”

Risk management strategy for preventing the reduced treatment effectiveness from the position of drug interactions and polypharmacy in patients with coronary heart disease

“…require a greater amount of therapy. Therefore, in the presence of a mutation of cytochrome Р450, on which most processes of drug biotransformation occur, there is a greater risk of the development of adverse reactions against the background of polypharmacy (Larock et al 2014;Page et al 2016;Dalin et al 2020;Foley et al 2020;Martinez et al 2020).…”

“…In this regard, it is very important to study the problem of polypharmacy in the Russian population. To solve a number of problems, which are defined by the Procedures for providing medical care in clinical pharmacology, a developed multi-component system of managing pharmacotherapy risks should be used (Khokhlov and Lisenkova 2003;Rakov et al 2003;Magro et al 2012;Starodubov et al 2012;Dalin et al 2020).…”