A study by researchers at RCSI University of Medicine and Health Sciences on drugs dispensed by general practitioners to older people led to an overall reduction in the number of drugs prescribed.
The research, published in PLOS Medicine, was chaired by Professor Susan Smith and Dr Caroline McCarthy of the Department of General Medicine at RCSI.
There are a growing number of older people living with multiple medical conditions, known as multimorbidity, who are prescribed multiple medications. This creates significant challenges for the healthcare system as a whole in terms of costs, as well as for the individual (and their caregivers) faced with taking so many medications, and for the clinicians who decide on this. that needs to be taken. The SPPiRE research project (Supporting prescribing in older people with multimorbidity and significant polypharmacy in primary care) aimed to address these challenges.
This study consisted of a randomized controlled trial involving 51 GP practices and 404 patients across the Republic of Ireland. Older multimorbid patients taking at least 15 regular medications were asked to attend a medication review with their GP. The review included screening their prescription for potentially inappropriate drug combinations, reviewing opportunities to discontinue drugs, and assessing the patient’s treatment priorities. He then assessed whether this unique review of drugs dispensed by a general practitioner reduced the number of drugs and improved the quality of prescribing.
There was a significant reduction in the number of drugs in the intervention group compared to the control group, with more than 800 drugs discontinued in 208 intervention patients. Of the 800+ drugs stopped, 15 possible adverse events were reported, almost all of which were mild reactions that stopped after the drug was reintroduced, indicating that stopping certain drugs in the elderly is generally safe.
Prescribing quality was also assessed using a checklist of potentially inappropriate drug combinations. Although there was no significant improvement in prescribing quality in the intervention group compared to the control group, overall there were improvements in both groups over the period. study.
Dr Caroline McCarthy, General Practitioner and Clinical Lecturer and Research Fellow in the Department of General Medicine at RCSI, said: “It is possible that the identification of this risk group for whom at least 15 drugs have been prescribed may have an impact. self helped improve prescribing. .
“It can be intimidating for GPs with limited time and resources to actively manage these prescriptions, and patients may also be wary of change, especially if they have been on a drug for a long time,” added Dr McCarthy.
The intervention approach to manage this difficult problem is promising and demonstrates that, even in this very complex group, stopping drugs that may no longer be needed or appropriate is both possible and generally safe. “
Professor Susan Smith, Associate Director, HRB Primary Care Clinical Trials Network
This research was funded by the HRB Primary Care Clinical Trials Network.
McCarthy, C., et al. (2022) Review of GP Drugs on Polypharmacy, Deprescribing, and Patient Priorities in Older People with Multimorbidity in Irish Primary Care (SPPiRE Study): A Cluster Randomized Controlled Trial. PLOS medicine. doi.org/10.1371/journal.pmed.1003862.