GP-led deprescribing in community living older Australians: A pragmatic, mixed methods, exploratory controlled trial

Not Applicable

Completed

• Conditions: Potentially inappropriate polypharmacy; Public Health - Health service research

• Registration Number: ACTRN12619000727145
• Lead Sponsor: niversity of Queensland

Brief Summary

After 18 weeks, the difference between intervention and usual care groups in the number of regular medicines deprescribed (ceased or dose reduced) per patient was approximately half a medicine. Adjusting for age, gender and number of regular medicines taken at the start of the study, intervention patients were more than twice as likely to have at least one regular medicine deprescribed than usual care patients. The intervention was not associated with any reported harm or deterioration in health-related quality of life which may have resulted from injudicious deprescribing attempts. A subset of intervention patients reported greater certainty in the necessity and appropriateness of their medicines at study end. The majority of GPs and patients derived satisfaction from the process of medicines review and consultation during deprescribing appointments, irrespective of whether the outcome of successful medicine withdrawal was achieved. Whilst seen as feasible in the short-term, GPs gave mixed responses regarding the sustainability of the intervention in routine care. Study limitations include: short-follow-up, the potential for bias in identifying patients eligible for deprescribing and the use of a convenience sample of interested practices and clinicians. The intervention was shown to be feasible and safe in the short-term, conferring clinically modest effect. This feasibility study holds important lessons for others undertaking research in this field.

Detailed Description

Not available

Study Timeline

• Results First Posted: 1900-01-01
• Study Completion: 2016-06-29
• Study Start: 2019-05-14
• Last Update Posted: 15 July 2019

Recruitment & Eligibility

• Status: Completed
• Sex: All
• Target Recruitment: 145

Inclusion Criteria

There were three participant groups.

1.General practitioners: Working in primary health care and caring for community living older people with polypharmacy; available to attend a deprescribing training workshop in August or September 2015 (intervention arm only); and working the equivalent of four or more, three-hour sessions per week (to ensure adequate access for patients to their usual GP).
While it was intended to recruit a diverse sample of GPs based on age, years of experience and gender balance, it was anticipated that GPs who had been in practice for a longer period may see a higher proportion of older patients compared to more recently qualified GPs. It was therefore accepted that the eligibility criteria may naturally lead to the recruitment of more experienced GPs and this was accepted as a limitation of the study.

2.Pharmacists: Experienced in and/or actively conducting Home Medicines Reviews (HMRs) (5 or more years since attaining accreditation preferred); available to attend a deprescribing training workshop in August or September 2015; willing to travel to provide HMR services to patients of recruited intervention practices.

3.Patients: Active patient of the practice as defined by the Royal Australian College of General Practitioner (RACGP) standards (i.e. had attended the practice three or more times in the past two years) and a regular patient of one of the GPs recruited to the study; aged 65 years or older and living in the community (and not in a Residential Aged Care Facility); taking eight or more regular medicines as listed in the GPs' electronic medical records; capacity to give consent; proficient in speaking and reading English; and contactable by telephone.

Exclusion Criteria

1.General practitioners: Primarily caring for people aged 65 years or older with polypharmacy residing in aged care facilities (as this was not the care setting of interest).

2.Pharmacists: Conducting medicine reviews primarily for residents in aged care facilities (as this was not the population of interest).

3.Patients: Confusion, cognitive impairment, mental health disorders with psychosis and/or communication difficulties (as documented or confirmed by the patient’s GP) that would preclude informed consent; terminal illness (life expectancy less than six months); a Home Medicines Review (HMR) in the 12 months prior to recruitment.

Study & Design

• Study Type: Interventional
• Study Design: Not specified