Development of a shared decision-making intervention to improve drug safety and to reduce polypharmacy in frail elderly patients living at home

Abstract

Objectives: For patients with geriatric frailty, reducing inappropriate medication is an important goal to improve patient safety in primary care. GP-side barriers include knowledge gaps, legal concerns, and lack of communication between the actors involved. The aim was to develop a multi-faceted intervention to facilitate deprescribing and shared prioritisation among frail elderlies with polypharmacy living at home.

Methods: Mixed methods study including: 1) scoping review on family conferences, expert panels; 2) group discussions with GPs, mapping of needs and challenges in Primary Care; 3) workshops and expert interviews with GPs, patient advocates, researchers as a basis for a theoretical intervention model; 4) piloting.

Results: A major challenge for GPs is to conduct a productive discussion with patients and family cares on deprescribing and drug safety. A guideline for a structured family conference with a medication check and geriatric assessment was developed and proved to be feasible in the pilot study.

Conclusion: The intervention developed to facilitate deprescribing and shared prioritisation of drug therapy based on family conferences seems suitable to be tested in a subsequent cRCT.

Innovation: Adapting family conferences to primary care for frail patients with polypharmacy.

Keywords: Deprescribing; Family Conference; Frailty; Polypharmacy; Primary Care.

Fig. 1

Overview of the intervention development process and piloting.

Fig. 2

Overview of results of STEP 1 of the intervention development.

Fig. 3

Theoretical framework of the COFRAIL intervention.

Fig. 4

COFRAIL Guideline Family Conference No. 1.

Fig. 5

Content of the COFRAIL Deprescribing Manual.

Fig. 6

Elements and objectives of the COFRAIL Non-Pharmacological Toolbox.