Deprescribing in older patients with hyperpolypharmacy: a cluster-randomised trial in primary care

BACKGROUND: Polypharmacy increases the risk of adverse drug events and potentially preventable hospital admissions. Deprescribing may reduce medication-related harm, and a clinical medication review (CMR) provides an opportunity to support this. OBJECTIVE: To investigate the effect of a deprescribing-focused CMR by trained pharmacists on the number of reduced and stopped medications among patients aged ≥75 years with hyperpolypharmacy using multidose-drug-dispensing (MDD)-systems. METHODS: In this cluster-randomised controlled trial, pharmacists were trained to perform a deprescribing-focused CMR, while control pharmacies provided usual care. Eligible patients were aged ≥75 years, had hyperpolypharmacy and used MDD. Dispensing data were used to determine the number of reduced and stopped medications per patient after 6 months (primary outcome). Secondary outcomes were: total number of medications, health problems and quality-of-life (EQ-5D-5L, EQ-VAS). A generalised linear mixed model was used for the primary outcome. RESULTS: A total of 318 patients from 58 pharmacies were enrolled (155 intervention, 163 control). At 6 months, patients in the intervention group had significantly more medications deprescribed than those in the control group (mean 2.5 vs. 1.7 per patient; mean difference 0.79, 95% CI 0.29-1.28; P = .002). There was no significant between-group difference in the total number of medications at 6 months (intervention -0.30 vs. control +0.12; P = .108). No significant differences were observed in health problems or quality-of-life. CONCLUSION: Deprescribing-focused CMRs by trained pharmacists successfully increased reduction and stopping of medications in older patients with hyperpolypharmacy using MDD-systems, while no changes in health problems or health-related quality of life could be observed over 6 months.