gms | German Medical Science

Background: Polypharmacy affects multimorbid and frail older people, increasing the risk of adverse drug events and hospitalisations [1]. A structured deprescribing process using a newly developed deprescribing manual was implemented in the COFRAIL study (funded by the GB-A innovation fund in Germany 01VSF17053, registered DRKS00015055) aiming to reduce hospitalisations.

Materials and Methods: The COFRAIL study was a cluster-randomised controlled trial conducted in ambulatory care with frail [2] elderly (≥70 yrs.) patients exposed to polypharmacy (≥5 drugs/d). In the intervention group, general practitioners carried out 3 family conferences with patients and their caregivers. In the first family conference, a structured medication review was conducted and assessed according to the deprescribing manual. This manual contains eleven indications, chosen according to their prevalence in geriatric patients and their potential for reducing drug burden. To explore whether and to what extent the suggestions from the manual have been implemented by general practitioners, drug prescriptions on medication plans from the first and second family conferences were reviewed and analysed.

Results: According to the medication plans reviewed at the first family conference, n=209 patients with a mean age of 83.3±5.84 years (66.5% females), received 10.3±4.0 drugs. After the first family conference, n=324 (15.1%) of the medications were deprescribed, dose reductions were observed for n=115 (5.4%) of the medications. The mean number of medications deprescribed and/or doses reduced per patient was 2.1±1.9. In the second family conference, medication plans from n=182 patients were reviewed. These patients had a mean number of medications with 9.0±3.8. A comparison of the medication plans, and reviewing the changes made by the GPS, show a reduction with respect to dose or deprescribing from 0.9±1,4 drugs/d in the period after the first and at the second family conference. At the same time, n=40 drugs deprescribed in the first family conference (12.3% of deprescribed drugs) were reinstated. The recommendations of the deprescribing manual were applied for n=448 (73.7%) of the deprescribed or dose reduced medications. In the remaining cases, drugs not mentioned in the manual were modified.

Conclusion: Applying the deprescribing manual resulted in a marked reduction of polypharmacy in frail elderly patients. In addition, the family conferences demonstrated a patient-centered approach for supporting this deprescribing. Further results from the COFRAIL study will show whether or not this intervention had effects on hospitalisations, quality of life, falls and healthcare costs.