Inappropriate Polypharmacy in Elderly Patients in Primary Care and Deprescribing in Older Patients With Frailty

University of Crete

Status: Active, not recruiting

Conditions: Polypharmacy; Medication Overuse; Frailty Syndrome; Deprescriptions

Treatments: Other: Medication Reviews and Deprescribing

Study type: Interventional

Funder types: Other

Identifiers

NCT06470308

93/12.06.2023

Details and patient eligibility

About

Polypharmacy is a major and growing public health problem occuring within all health care settings worldwide. The systematic review of Mansoon et al,2017 identified 138 different definitions for polypharmacy from which the most commonly used numerical definition is being this of five or more medicines. However, numerical definitions do not take into account factors such as comorbidity thus there is a need for a a shift towards the terms "appropriate" ,and "inappropriate polypharmacy" and potentially inappropriate prescribing (PIP). The prevalence of polypharmacy varies between 10% to as high as around 90% depending on the definition used and the population that is studied.There is worldwide literature regarding the epidemiology of polypharmacy in the elderly , health outcomes and cost. The is an abundance of guidelines and tools regarding deprescribing, the process of withdrawal of an inappropriate medication, supervised by a health care professional with the goal of managing polypharmacy , minimizing inappropriate medication and improving outcomes. In Greece , as pointed out by the SIMPATHY project, there is no formal polypharmacy initiative and relative greek literature is scarce.There is no research in Greece regarding the prevalence of PIP among community-dwelling elderly patients as well as there are no studies evaluating the feasibility or effectiveness of deprescribing interventions in the elderly or older patients with frailty.

The aim of this thesis is to record, in the primary care setting in Crete, the underlying barriers and enablers of deprescribing among health care professionals and also to evaluate ,the clinical outcomes of deprescribing interventions in primary care. Additionally, the beliefs and attitudes of the patients and/or their caregivers towards deprescribing will be recorded.

Enrollment: 255 estimated patients

Sex: All

Ages: 65+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• community-dwelling patients
• Age ≥ 65 years
• Receive at least 5 medication ( polypharmacy )

Exclusion criteria

• hospitalized or patients living in nursing home
• Incapable of giving written consent

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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255 participants in 2 patient groups

Intervention Arm

Experimental group

Description:

An educational intervention and training in deprescribing algorithms and deprescribing tools ( Beers Criteria, STOPP/START) will be provided to the general practitioners caring for the patients selected in the intervention arm.

Treatment:

Other: Medication Reviews and Deprescribing

Control Arm

No Intervention group

Description:

No educational intervention will be provided to the general practitioners of the selected patients.