Feasibility of implementing an intervention in general practice for deprescribing of glucose-lowering medication in overtreated elderly.

Abstract

Elderly patients with Type 2 diabetes (T2D) are frequently overtreated with glucose-lowering medication. This feasibility study evaluated the implementation of a deprescribing programme (DPP) for general practices, consisting of education, a patient selection tool, practice visits, and an expert support panel, before scaling it in a randomized controlled trial. Quantitative evaluation included the number of patients with T2D eligible for deprescribing using medical records and study progress data. Qualitative evaluation entailed the analysis of minutes made during training, and interviews with health care providers (HCPs). The extended normalization process theory guided analysis. In 10 practices, 55 out of 65 eligible patients were deprescribed glucose-lowering medication, with 22 restarts. Most execution steps were perceived as the practice nurse's responsibility, whereas the general practitioner needed to approve the deprescribing. Practice nurses found the educational training, including peer-to-peer sessions and practice visits, supportive of integrating deprescribing into practice. DPP procedures and tasks not part of the regular care process were not consistently performed. The DPP was adapted to minimize study tasks for HCPs and align study procedures to existing routine procedures. Implementation of a DPP in general practice requires education, practice visits, and alignment of DPP components to regular care.