Analysis of polypharmacy in older patients in primary care using a multidisciplinary expert panel

Abstract

Background: Many older patients suffer from chronic diseases for which medicines should be used. Because of the higher number of medicines used and decline in hepatic and renal function, older patients are more prone to problems caused by these medicines. Therefore, it is important to review pharmacotherapy concerning older patients in primary care in a reliable way.

Aim: To determine the nature, volume and clinical relevance of prescription-related points of attention in the elderly.

Design of study: Analysis of pharmacotherapy by a multidisciplinary expert panel consisting of GPs, geriatric specialists, clinical pharmacists and community pharmacists.

Setting: Pharmacotherapy of 102 home-dwelling older patients on polypharmacy (> or =75 years, using > or =4 medicines continually) living in the Netherlands.

Method: The analysis of medication-profiles was based on a two-round consensus method.

Results: When performing medication reviews for older people it seemed that for almost all (98%) improvement in pharmacotherapy could be made. For 94% of all patients points of attention could be identified in prescribed medicines, of which 30% was considered to be of direct clinical relevance. In 61% of all patients a medicine could be added to improve pharmacotherapy, 25% of these prescribing omissions were considered to be of direct clinical relevance.

Conclusion: The regular performance of medication reviews should be part of routine in primary care as it yields significant numbers of prescription-related points of attention. Although they were not all considered to be of direct clinical relevance, all points of attention do ask for a signal to the prescribing physician. This paper is not implying poor practice or poor reviewing practice but documenting the need for performing regular medication reviews.