Gert Baas, SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands
Mette Heringa, SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands
Sanne Bakker-Verdoorn, SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands
Henk-Frans Kwint, SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands
Jacobijn Gussekloov, Leiden, Public Health and Primary Care, Leiden University Medical Center, The Netherlands
Marcel Bouvy, Department of Pharmacoepidemiology & Pharmacotherapy, University of Utrecht, Utrecht, The Netherlands
ABSTRACT
Background:
The number of older patients with polypharmacy will keep increasing the next decades. Polypharmacy has been linked to increased risk of adverse drug reactions. Although deprescribing guidelines are available, older people often continue the use of chronic medication without regular reconsideration of its appropriateness.
Objective:
To test the feasibility an intervention consisting of a clinical medication review focused on deprescribing in older people using a multidose drug dispensing (MDD) systems.
Methods:
Pharmacists received a training and toolbox about performing clinical medication reviews focused on deprescribing and taking into account patient’ preferences and health problems. The pharmacists conducted this intervention in older people (≥75 years) with hyperpolypharmacy using a MDD-system. They registered drug related problems and interventions. Patients, pharmacists and general practitioners were interviewed about their experience and content analysis was performed.
Results:
Five pharmacists included 22 patients (mean 84 years old, 59% female) Per patient 4,5 drug-related problems were registered by the pharmacist. In 20 patients (91%), at least one deprescribing recommendation was made. The implementation rate of deprescribing recommendations was 75%. The provided training and toolbox were evaluated positively by the pharmacists. Pharmacists mentioned a limited number of eligible patients to recruit. Both pharmacists and GPs experienced barriers to deprescribe in patients who are also treated in secondary care. Patients were satisfied with the provided information on deprescribing and valued the pharmacists’ listening skills.
Conclusion:
This pilot study suggests that the pharmacist-led clinical medication review focused on deprescribing is feasible and have a potential impact to reduce overtreatment in older people with hyperpolypharmacy and MDD-systems. Both health care professionals and patients were positive about the intervention. To optimise the effect of the intervention, improvements can be made to the training and data collection procedures.