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Randomized Controlled Trial
. 2023 Feb;45(1):191-200.
doi: 10.1007/s11096-022-01497-2. Epub 2022 Nov 16.

Medication changes and potentially inappropriate prescribing in older patients with significant polypharmacy

Caroline McCarthy  1 , Michelle Flood  2 , Barbara Clyne  3 , Susan M Smith  3   4 , Emma Wallace  3 , Fiona Boland  3   5 , Frank Moriarty  3   2
Affiliations
Randomized Controlled Trial

Medication changes and potentially inappropriate prescribing in older patients with significant polypharmacy

Caroline McCarthy et al. Int J Clin Pharm. 2023 Feb.

Abstract

Background: Number of medicines and medicines appropriateness are often used as outcome measures to evaluate the effectiveness of deprescribing interventions.

Aim: The aim of this study was to evaluate changes in prescribing, potentially inappropriate prescriptions (PIP) and prescribing of low-value medicines in older people with multimorbidity and significant polypharmacy.

Method: This study was a retrospective secondary analysis of prescription data from a cluster randomised controlled trial involving 404 participants aged ≥ 65 years and prescribed ≥ 15 repeat medicines from 51 different general practices. For this study, repeat medications at baseline and follow-up (~ 1 year later) were assigned Anatomical Therapeutic Classification (ATC) codes. Outcomes were the most commonly prescribed and potentially inappropriately prescribed drug groups, the most frequently discontinued or initiated drug groups and the number of changes per person between baseline and follow-up.

Results: There were 7051 medicines prescribed to 404 participants at baseline. There was a median of 17 medicines (IQR 15-19) at baseline and 16 (IQR 14-19) at follow-up. PIP represented 17.1% of prescriptions at baseline and 15.7% (n = 6777) at follow-up. There were reductions in the prescription of most drug groups with the largest reduction in antiplatelet prescriptions. Considering medication discontinuations, initiations and switches, there was a median of five medication changes per person (range 0-30, IQR 3-9) by follow-up. There were 95 low-value prescriptions at baseline reducing to 78 at follow-up.

Conclusion: The number of medication changes per person was not reflected by summarising medication count at two time points, highlighting the complexity of prescribing for patients with polypharmacy. Frequent medication changes has potentially important implications for patients in terms of adherence and medication safety.

Trial registry: The SPPiRE trial was registered prospectively on the ISRCTN registry (ISRCTN12752680).

Keywords: Cluster randomised controlled trial; Deprescribing; Multimorbidity; Polypharmacy; Potentially inappropriate prescribing.

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References

    1. Fortin M, Stewart M, Poitras ME, et al. A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology. Ann Fam Med. 2012;10(2):142–51. - DOI - PubMed - PMC
    1. Khezrian M, McNeil CJ, Murray AD, et al. An overview of prevalence, determinants and health outcomes of polypharmacy. Therapeut Adv Drug Saf. 2020;11:2042098620933741.
    1. Masnoon N, Shakib S, Kalisch-Ellett L, et al. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230. - DOI - PubMed - PMC
    1. Spinewine A, Schmader KE, Barber N, et al. Appropriate prescribing in elderly people: How well can it be measured and optimised? Lancet. 2007;370(9582):173–84. - DOI - PubMed
    1. Wallace J, Paauw DS. Appropriate prescribing and important drug interactions in older adults. Med Clin North Am. 2015;99(2):295–310. - DOI - PubMed

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