Medicine Review Reduces Polypharmacy in Older Adults

A study published this month looked to see if an intervention delivered by primary care doctors could reduce the use of potentially inappropriate prescriptions (PIPs) and polypharmacy in community-dwelling older adults with multiple health conditions.

The cluster randomized controlled trial (RCT) took place in the Republic of Ireland, where, according to the researchers, 1 in 5 adults aged 50 and almost half of those aged 75 years or above take 5 or more regular medications.

The RCT involved 51 GP practices and 404 patients and sought to determine if a one-time medication review reduced the number of medicines and improved the quality of prescribing. Patients were recruited from April 2017 and followed up until October 2020.

Twenty-six GP practices delivered the intervention, receiving access to the study website, where they completed an educational lesson and obtained a template for a discussion with older patients with multimorbidity taking at least 15 regular medicines. This medication review screened for potentially inappropriate combinations of medicines, considered opportunities for stopping medicines, and assessed the patient’s priorities for treatment.

Twenty-five practices acted as controls and delivered the usual patient care.

An independent pharmacist, blinded to the groups, assessed primary outcome measures defined as the number of medicines and the proportion of patients with any PIP, from a predefined list of 34 indicators based predominantly on the Screening Tool of Older People’s Prescriptions / Screening Tool to Alert to Right Treatment version 2 criteria.

At baseline, patients had a mean of 17.37 (3.50) prescriptions and a substantial amount of comorbidities.

At 6-month follow-up, patients in both groups had reductions in the numbers of prescriptions, with a small but significantly greater reduction in the intervention group (incidence rate ratio [IRR], 0.95; 95% CI, 0.899 to 0.999; P = .045).

However, there was no significant effect on the odds of having at least 1 PIP in the intervention versus control group (odds ratio [OR], 0.39; 95% CI, 0.140 to 1.064; P = .066).

The quality of prescribing was also examined via a checklist of potentially inappropriate combinations of medicines. There were improvements in both groups, and no statistically significant differences between them.

Overall, 1398 medicines were stopped and 1153 medicines started, and over 80% of participants had at least 1 medicine stopped and started. Out of 826 medicines stopped in the intervention group, 15 adverse drug withdrawal events were reported.

The researchers said the results of the study would have bigger population-level effects if medication reviews and deprescribing was conducted on a regular basis.

The main limitation of the study is that outcome measures were assessed at just 1 point in time; researchers said they were unable to access electronic health information due to a change in the study protocols.

Reference

McCarthy C, Clyne B, Boland F, et al. GP-delivered medication review of polypharmacy, deprescribing, and patient priorities in older people with multimorbidity in Irish primary care (SPPiRE Study): A cluster randomised controlled trial. PLoS Med. Published online January 5, 2022. doi:10.1371/journal.pmed.1003862