Implementing a medication review and deprescribing intervention for older people living with frailty and polypharmacy in general practice: a feasibility study.

Abstract

Polypharmacy in older adults with frailty increases risks of adverse outcomes. Evidence supports proactive structured medication reviews (SMRs) for medicines optimisation, including deprescribing, however challenges exist in general practice. To test the implementation of a co-designed multidisciplinary SMR intervention (MODIFY) for this high-risk group. A non-randomised pre-post feasibility study was conducted across five general practices in England. The multidisciplinary intervention comprised five components including patient and health care professional (HCP) preparation. Patients aged ≥75 with moderate-to-severe frailty (eFI >0.25) and ≥5 medications were identified and invited to participate.Primary outcomes were recruitment, retention, and completion of outcome measures. Secondary outcomes included medication-related outcomes, healthcare utilisation, adverse drug reactions, and acceptability to patients and HCPs based on qualitative interviews. Of 479 patients invited, 48 were recruited (10% rate); 47 received the intervention, 43 completed three-month follow-up (92% retention). Medication changes occurred in 87% of participants; 72% had at least one medication stopped and 26% had a dose reduced. The mean number of medications decreased slightly by 0.27 (SD:1.44) without significant change in clinical and patient-reported outcomes (including function, frailty status, treatment burden) and no reported adverse events. Qualitative interviews with 10 patients, 1 carer, and 8 HCPs, indicated high acceptability and perceived value, and suggested improvements.Economic data was well completed. SMRs cost £28.50 per patient. Participants' reported quality of life improved slightly over three months. The MODIFY intervention is feasible and acceptable for deprescribing in primary and support progression to a definitive trial.