A Clinical Medication Review Focused on Deprescribing in Older Patients With Hyperpolypharmacy: A Mixed-Methods...

Area of Science:

• Geriatric Medicine
• Pharmacology
• Primary Care Research

Background:

• Hyperpolypharmacy in older adults presents significant deprescribing challenges.
• Clinical Medication Reviews (CMRs) are a potential avenue for deprescribing, but require optimization.
• Healthcare provider (HCP) training is crucial for effective deprescribing interventions.

Purpose of the Study:

• To assess the feasibility of a deprescribing-focused intervention for older patients with hyperpolypharmacy in primary care.
• To evaluate the acceptability and potential of adding deprescribing to CMRs.
• To identify barriers and facilitators for implementing deprescribing interventions.

Main Methods:

• A mixed-methods feasibility study in six Dutch community pharmacies.
• Intervention included HCP training and a five-step deprescribing-focused CMR.
• Bowen's framework assessed 18 outcomes via questionnaires, interviews, process data, and dispensing records.

Main Results:

• The intervention was well-accepted by patients and HCPs.
• Pharmacists conducted CMRs with 24 patients (median age 84.5 years), deprescribing an average of 1.3 medications per patient.
• Barriers included incomplete patient concern discussion, variable HCP confidence, and time constraints.

Conclusions:

• Deprescribing interventions integrated into CMRs are feasible and well-received for older patients with hyperpolypharmacy.
• High acceptability and deprescribing potential were noted.
• Implementation and practicality barriers necessitate further evaluation in broader primary care settings.