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. 2020 Jul;86(7):1326-1335.
doi: 10.1111/bcp.14243. Epub 2020 Mar 16.

Development of a structured clinical pharmacology review for specialist support for management of complex polypharmacy in primary care

Christopher J D Threapleton  1   2 , James E Kimpton  1   2 , Iain M Carey  3 , Stephen DeWilde  3   4 , Derek G Cook  3 , Tess Harris  3   5 , Emma H Baker  1   2
Affiliations

Development of a structured clinical pharmacology review for specialist support for management of complex polypharmacy in primary care

Christopher J D Threapleton et al. Br J Clin Pharmacol. 2020 Jul.

Abstract

Aims: Polypharmacy is widespread and associated with medication-related harms, including adverse drug reactions, medication errors and poor treatment adherence. General practitioners and pharmacists cite limited time and training to perform effective medication reviews for patients with complex polypharmacy, yet no specialist referral mechanism exists. To develop a structured framework for specialist review of primary care patients with complex polypharmacy.

Methods: We developed the clinical pharmacology structured review (CPSR) and stopping by indication tool (SBIT). We tested these in an age-sex stratified sample of 100 people with polypharmacy aged 65-84 years from the Clinical Practice Research Datalink, an anonymised primary care database. Simulated medication reviews based on electronic records using the CPSR and SBIT were performed. We recommended medication changes or review to optimise treatment benefits, reduce risk of harm or reduce treatment burden.

Results: Recommendations were made for all patients, for almost half (4.8 ± 2.4) of existing medicines (9.8 ± 3.1), most commonly stopping a drug (1.7 ± 1.3/patient) or reviewing with the patient (1.4 ± 1.2/patient). At least 1 new medicine (0.7 ± 0.9) was recommended for 51% patients. Recommendations predominantly aimed to reduce harm (44%). There was no relationship between number of recommendations made and time since last primary care medication review. We identified a core set of clinical information and investigations (polypharmacy workup) that could inform a standard screen prior to specialist review.

Conclusion: The CPSR, SBIT and polypharmacy workup could form the basis of a specialist review for patients with complex polypharmacy. Further research is needed to test this approach in patients in general practice.

Keywords: clinical pharmacology; drug utilization; frailty; long-term conditions; medication review; prescribing; primary care; quality use of medicines.

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Conflict of interest statement

There are no competing interests to declare.

Figures

Figure 1
Figure 1
Clinical measurements and investigation results considered essential (black bars) and useful (grey bars) for making prescribing decisions. BMI, body mass index; BNP, B‐type natriuretic peptide; CRP, c‐reactive protein; ESR, erythrocyte sedimentation rate; FEV‐1, forced expiratory volume in 1 second; HbA1c, haemoglobin A1c; HDL, high‐density lipoprotein; INR, international normalised ratio; LDL, low‐density lipoprotein; OGD, oesophagogastroduodenoscopy; RAST, radioallergosorbent test; TSH, thyroid stimulating hormone
See this image and copyright information in PMC

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