The Effect of a Comprehensive, Interdisciplinary Medication Review on Quality of Life and Medication Use in Community Dwelling Older People with Polypharmacy

Abstract

We conducted a comprehensive medication review at the patients’ home, using data from electronic patient records, and with input from relevant specialists, general practitioners and pharmacists formulated and implemented recommendations to optimize medication use in patients aged 60+ years with polypharmacy. We evaluated the effect of this medication review on quality of life (QoL) and medication use. Methods: Cluster randomized controlled trial (stepped wedge), randomly assigning general practices to one of three consecutive steps. Patients received usual care until the intervention was implemented. Primary outcome was QoL (SF-36 and EQ-5D); secondary outcomes were medication changes, medication adherence and (instrumental) activities of daily living (ADL, iADL) which were measured at baseline, and around 6- and 12-months post intervention. Results: Twenty-four general practices included 360 women and 410 men with an average age of 75 years (SD 7.5). A positive effect on SF-36 mental health (estimated mean was stable in the intervention, but decreased in the control condition with −6.1, p = 0.009,) was found with a reduced number of medications at follow-up compared to the control condition. No significant effects were found on other QoL subscales, ADL, iADL or medication adherence. Conclusion: The medication review prevented decrease of mental health (SF36), with no significant effects on other outcome measures, apart from a reduction in the number of prescribed medications.

Individualized Medication Review in Older People with Multimorbidity: A Comparative Analysis between Patients Living at Home and in a Nursing Home

“…A recent systematic review highlights the paucity of research into the impact of optimizing prescriptions on clinical outcomes in older people living with frailty [ 55 ]. However, there is some evidence that MR can reduce the number of hospital readmissions among older people [ 56 ] and can prevent the decline of mental health, with no significant effects on other outcome measurements, apart from a reduction in the number of prescribed medications [ 57 , 58 ]. Thus, overall it is accepted that several studies suggest that medication optimization could be safe, feasible well-tolerated, and lead to important benefits [ 55 ].…”

Feasibility of a pharmacist-facilitated medicines review intervention for community-dwelling Māori older adults

“… 44 The EQ-5D QoL tool 45 could be considered as an alternative, although recent research investigating a similar medicines review intervention as in our current study showed QoL scores improved when measured using SF-36 but not when using EQ-5D. 46 …”

Polypharmacy trajectories among older women with and without dementia: A longitudinal cohort study

“…GPs are ideally involved in optimizing medication management among older population. 60 A case vignette study conducted in 31 European countries among older patients to investigate GPs deprescribing decision reported that most of the GPs were willing to deprescribe, especially for patients with multimorbidity. 61 Higher likelihood of polypharmacy among women with higher GP visits in our study could be indicative of a need for effective implementation of interprofessional collaboration of GPs, pharmacists, and nurses to promote deprescribing and enable non-pharmacological supports.…”